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

Is the Seclusion Policy of Mental Health Care Users a Necessary Evil?

Background. Seclusion in the psychiatric context is the involuntary confinement of an agitated; unstable person alone in a contained; controlled environment. Differing views on seclusion presents clinicians with an ethical dilemma.Significant morbidity and mortality have been associated with seclusion. No data exist in South Africa on rates of seclusion for psychiatric purposes. Consequently neither the need for seclusion nor alternatives to seclusion have been explored. Objective. To determine the number of patients secluded over six months; provide a profile of patients that were secluded; and to ascertain the reasons for seclusion.Methods. A retrospective record review of patients secluded at Sterkfontein Hospital; over a six-month period.Results. A total of 112 patients were secluded over the six-month period. Users were secluded for a total of 59 415.5 hours and on 4 814 separate occasions. A total of 84.8% of the users secluded were male. The mean age of users secluded was 29 years. Just under half the users (49.1%) were secluded for their own safety and 40% of users were secluded for aggression (either physical or verbal). The most common diagnosis was schizophrenia (31.4%) followed by cognitive impairment (20.6%) and bipolar mood disorder (13.7%). The most commonly used medication was sodium valproate (17%); followed by haloperidol (11%) and risperidone (11%).Conclusion. Younger male patients with psychosis were most likely to be secluded. More research should be conducted locally to compare seclusion rates and patient profiles so that we may improve seclusion practices