The psycho-social and clinical profile of women referred for psycho-legal evaluation to forensic mental health units in South Africa

Background: There is a paucity of research on women offenders in the South African context, particularly those referred for forensic psychiatric observation. Little is known about their life histories, the nature of their offences or the psycho-social contexts that enable, or are antecedents to, women's criminal offending. Aims: This research study, the largest of its kind in South Africa, examined the psycho-social contexts within which women offenders referred for psychiatric evaluation come to commit offences. The profiles of both offenders and victims, as well as reasons for referral and forensic mental health outcomes, were investigated. Methods: A retrospective record review of 573 cases, spanning a 12-year review period, from six different forensic psychiatric units in South Africa, was conducted. Results: The findings describe a population of women offenders who come from backgrounds of socio-demographic and socio-economic adversity, with relatively high pre-offence incidences of being victims of abuse themselves, with significant levels of mental ill-health and alcohol abuse permeating their life histories. The majority of index offences which led to court-ordered forensic evaluations were for violent offences against the person, with murder being the single most common index offence in the sample. Most victims of violence were known to the accused. There were also relatively high rates of psychotic and mood-spectrum disorders present, with relatively low rates of personality disorders. The majority of women were deemed to be trial competent and criminally responsible in relation to their index offences. Conclusion: It is recommended that more standardised and gender-sensitive forensic mental health assessment approaches, documentation and reporting be employed throughout the country. Future research should compare male and female offending patterns and forensic mental health profile

Forensic psychiatric assessment process and outcome in state patients in KwaZulu-Natal, South Africa

Background: Individuals who were charged with a serious offence may be referred by courts for forensic psychiatric assessment. The court may declare them as state patients if they are found unfit to stand trial or not criminally responsible because of mental illness or defect. In forensic psychiatry practice, there may be challenges in the forensic psychiatric observation process, and discrepancies may occur between the clinician report and the court's decision. Objectives: To describe elements of the forensic psychiatric observation and discuss the legal correlates associated with the admission of state patients. Method: A retrospective study of the forensic psychiatric observation records of 91 newly admitted state patients at a forensic unit in KwaZulu-Natal over a 3-year period. Results: A total of 71 state patients (78.02%) were found not fit to stand trial and 10 patients (10.99%) were not criminally responsible. Nine patients (9.89%) were fit to stand trial and criminally responsible but still declared state patients and 13 state patients (14.29%) did not commit a serious offence. There was correlation for diagnosis between the assessing and the treating psychiatrists. Conclusion: The findings of the forensic observation were not always considered by the courts. Individuals found fit to stand trial, those found criminally responsible and those who did not commit serious crimes were declared state patients. A better understanding of legal dispositions for mentally ill offenders and an active collaboration between judicial and mental health systems may contribute in developing national guidelines for observation and admission of state patients

A 4-year review of psychiatrists' participation in prosecutorial workshops on criminal capacity

Objective. The objective was to review psychiatric involvement in seven prosecutorial workshops on criminal capacity between 2004 and 2009. The aim was to evaluate the changing role of the psychiatrists in the workshops in order to identify areas in forensic psychiatry where prosecutors have a specific need for training; and to identify more suitable methods of training. Method. The workshop programmes; copies of presentations; the number of attending prosecutors at each workshop; informal personal notes from the presenters; suggestions from meetings in preparation for workshops and formatted feedback reports were reviewed. Information from a total of seven workshops was reviewed and interpreted by 2 psychiatrists from Weskoppies Hospital Forensic Psychiatry Unit (WHFPU). Results. The psychiatrists' involvement increased over the years. Problematic topics that were identified include non-pathological criminal incapacity; child psychiatry and the different roles of the psychiatrist and the psychologist in court. Exposure to practical aspects; interactive workshops with case presentations; discussion groups and audience participation seemed to be the preferred method of training. Attitudes of prosecutors towards psychiatry improved with increased knowledge and understanding of the field; and overall the training was rated as relevant and enriching. Conclusion. Psychiatrists can offer valuable training opportunities to legal professionals about the major mental illnesses and how they can affect criminal capacity; but evaluation of the training should be an ongoing process to address changing needs. Training sessions provide an opportunity for reciprocal sensitisation between the different fields. The ultimate goal is to work towards improved association between the criminal justice and mental health systems

Telepsychiatry in South Africa ­ present and future

The recent progress in telepsychiatry results from advancing technology and videoconferencing as an effective alternative to classic face-to-face psychiatric interaction, in terms of both results and cost-effectiveness. The wide range of applications of telepsychiatry is outlined - in particular, emergency, forensic, prison and adolescent psychiatry. Attitudes of patients and the providers of psychiatric services are discussed, and a short account is given of the place of tele-education in psychiatric teaching. The advantages of telepsychiatry are outlined and its limitations. Lastly, the limited experience and relevance of telepsychiatry in South Africa (and hence for other developing countries) are presented. The conclusion is that telepsychiatry is well established, its successes documented, and that it should be applied in planning future public health services in South Africa