Forensic Mental Health Services: Current Service Provision and Planning for a Prison Mental Health Service in the Eastern Cape

By Sukeri, Kiran; Betancourt, Orlando A. et al. | South African Journal of Psychiatry, February 2016 | Go to article overview

Forensic Mental Health Services: Current Service Provision and Planning for a Prison Mental Health Service in the Eastern Cape


Sukeri, Kiran, Betancourt, Orlando A., Emsley, Robin, Nagdee, Mohammed, Erlacher, Helmut, South African Journal of Psychiatry


Introduction

The Royal College of Psychiatrists (1) defines forensic psychiatry as a specialty within psychiatry concerned with helping people who have a mental disorder and who present with a significant risk to the public. It covers areas such as, the assessment and treatment of mentally disordered offenders and prisoners. In South Africa, the Colleges of Medicine has recently recognised Forensic Psychiatry as a subspecialty. (2)

Forensic psychiatric services exist at the interface between mental health and the criminal justice system sectors. In terms of Chapter 13 of the Criminal Procedure Act 51 of 1977 section 78(2) (3), the justice sector identifies those who have mental health problems and they are assessed in a mental health setting and formal reports are provided. Chapters 6 and 7 of the Mental Health Care Act, no 17 of 2002 (4) make provision for the management of State patients (people who have committed an offence and who have been found to be unfit to stand trial or not criminally responsible as a result of mental illness) and mentally ill prisoners respectively. In addition to the above, the Department of Correctional Services identifies prisoners who may require mental health assessment and treatment and in terms of the Correctional Services Act (5), it is the responsibility of the Department of Health to provide health services to prisoners.

In the Eastern Cape forensic psychiatric services are provided by Komani Hospital (single psychiatrist observations only) and Fort England Hospital (FEH), Grahamstown. (6) The latter hospital conducts the majority of psycho-legal evaluations in the province. A task team set up by the National Department of Health found that there was no dedicated observation unit at Komani Hospital and that accommodation was shared by 'observanda' (defined as 30 day psychiatric evaluation of awaiting-trial prisoners, as per sections 77, 78 and 79(2) of the Criminal Procedure Act (3)) and State patients. The task team's macro recommendation was that Komani Hospital required a new unit. (7) The nature of services provided at FEH6 are as follows:

* The psycho-legal evaluation of observanda referred by courts in terms of sections 77, 78 and 79 of the Criminal Procedure Act. (3)

* The accommodation of State Patients in terms of section 42 of the Mental Health Care Act. (4)

* Admission and management of mentally ill prisoners.

This comprehensive forensic psychiatric service provided only by FEH is for a population of 6 743 800.8 The hospital is located in the Cacadu District Municipality.

The forensic section of FEH consists of 189 designated male beds: 35 in each of four State patient wards and 49 beds in the maximum security unit (20 'observanda' and 29 State patient or mentally ill prisoners). Female observanda and State patients are admitted to the generic female ward. New observanda and State patients are admitted either to the maximum security unit, Ward H (male State patients admission ward) or the generic female ward.

Mentally ill prisoners requiring ambulatory care are referred to the nearest mental health unit to the prison in which they are held.

The Eastern Cape has 45 correctional centres. At the time of the study (January 2010 to December 2010) the prison population in the Eastern Cape stood at 19 265 (449 females, 18 816 males). The national prison population for the same period was 160 545. The province has the second highest occupancy rate in the country (146.35%, the country average being 135.87%). (9) The province does not have a prison mental health service, prison liaison or in-patient services and there are no services for children and adolescents in the youth justice system. Only two correctional centres report that a psychologist is consulted as needed. No correctional centre has a resident or visiting psychiatrist. (9)

The province does not have a long term care policy for the management of Sate patients and/or mentally ill prisoners i. …

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