Corresponding author : B Marais (Belinda.Marais@gauteng.gov.za) Background. State patients are individuals who have been charged with offences involving serious violence and who have been declared unfit to stand trial and/or who are not criminally responsible because of their mental illness or defect. They are referred by the courts for treatment, rehabilitation and indefinite detention at a forensic psychiatric facility. However, many of these state patients may ultimately be released back into the community. As these individuals may be considered a high-risk group, their rates of relapse and recidivism are of importance. There is a paucity of South African literature on the long-term outcome of state patients. Objective. To describe the profile of state patients, and to examine their outcomes after 3 years, including recidivism rates. Methods. A descriptive, retrospective study of the clinical records of 114 state patients admitted to Sterkfontein Hospital in 2004 and 2005 was conducted, and their profile and 3-year outcomes were determined. Results. The majority of state patients were male, single, unemployed, had a past psychiatric history (59%), and substance abuse history (71%). A third reported a past criminal history. The most common offences were assault with the intention to do grievous bodily harm (19%), rape (18%) and murder (13%). Psychotic disorders represented the most common diagnostic category (69%), with schizophrenia being the most frequent diagnosis (44%). Most state patients had been found unfit to stand trial (96%) and not criminally responsible (89%). At the end of the 3-year follow-up, the majority were in the community (69%), of whom most (72%) were out on leave of absence (LOA), while a quarter had absconded and a minority were reclassified (3%). Most absconders (83%) were state patients who had not returned from LOA. The recidivism rate was 4%. Conclusion. Most state patients were out in the community at the end of the 3-year period. The following recommendations are suggested: improved community psychiatric services, especially for those diagnosed with psychotic disorders and mental retardation, with a focus on improving treatment adherence and early detection of treatment defaulters; improved substance abuse rehabilitation programmes and community facilities, as well as strengthening of systems that manage absconders.S Afr J Psychiatr 2015;21(3):86-92.

Introduction: Filicide is the deliberate act of a parent killing his/her own child and a major contributor to child homicide rates. In order to prevent future homicides of this nature and aid in the rehabilitation of those mentally ill women who perpetrate these crimes, it is important to gain a better understanding of the dynamics that may result in filicide and the association of the mental illness with filicide. It is also important to explore how the rehabilitation processes are experienced and the impact they have had. The purpose of this study was to examine the perceptions of women regarding their offenses and their perceptions about their treatment and rehabilitation in a South African context.Method: This was a qualitative study which followed a naturalistic paradigm. The data from the semistructured interviews conducted were analyzed using thematic analysis. The use of subjective experiences and descriptions by the participants aimed to give a representation of the participants’ lived experience. This allowed the authors to explore the emerging themes, subthemes, and concepts and organize the most replicated information into a hierarchical assessment. The semistructured interviews were conducted with seven filicidal women with mental illness between July 2016 and April 2017 at Sterkfontein Hospital, Gauteng, South Africa.Results: Most filicidal mothers were psychotic at the time of the offense and perceived trauma and remorse for their offenses. Support from the community and empathy and unconditional positive regard from the staff, notably psychologists, and occupational therapists were overwhelmingly present.Conclusion: Filicide is tragic and largely understudied, particularly from the perpetrator’s perspective. When perpetrators are mentally ill, rehabilitation within a nonjudgmental and empathetic environment is necessary.

Background/objectiveIn South Africa, approximately 40% of women suffer from depression during pregnancy. Although perinatal depression and anxiety are significant public health problems impacting maternal and infant morbidity and mortality, no routine mental health screening programmes exist in the country. A practical, accurate screening tool is needed to identify cases in these busy, resource-scarce settings.MethodA convenience sample of 145 women between 22 and 28 weeks gestation was recruited from Rahima Moosa Hospital antenatal clinic in Johannesburg. All women completed a biographical interview, the Edinburgh Postnatal Depression Scale (EPDS), the Whooley questions and a structured clinical interview.ResultsThe results demonstrate the sensitivity and specificity of the Whooley questions and the EPDS in identifying depression, anxiety and stress disorders of varying severity. The importance of personal, social and cultural context in influencing the content and expression of these common perinatal conditions was also identified.Discussion and conclusionThe validity of the Whooley questions in the context of urban South Africa, and the importance of ensuring clinical interviews to supplement any screening tools, is emphasised.

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Background: Intimate partner homicide (IPH) is a global public health problem. One study conducted over 66 countries found that 13.5% of all homicides and 38.6% of female homicides were committed by an intimate partner. In South Africa, there were no published studies that examine alleged perpetrators of IPH that were referred for forensic psychiatric observation.Aim: To describe the profile of accused persons referred for forensic psychiatric observation for a charge of murder or attempted murder of their intimate partners. Certain characteristics were further examined according to the psychiatric observation outcomes.Setting: The study was conducted at Sterkfontein Hospital, a forensic psychiatric hospital in Gauteng, South Africa.Methods: A retrospective record review of accused persons referred for forensic psychiatric observation for a charge of murder or attempted murder of their intimate partners was conducted. The period of the review was 19 years. The definition of intimate partners included current or former spouses and partners, same-sex partners and rejected suitors.Results: One hundred and sixty-three files, which included forensic psychiatric reports, were reviewed. The findings related to the profile of accused persons and offence characteristics indicated that: (1) history of violent behaviour is prevalent; (2) homicides mostly occur in private homes; (3) knives and firearms are most often used; (4) infidelity, separation and jealousy are common motives; (5) psychotic disorders, personality disorders and substance use disorders feature prominently. A total of 88% of the sample were found fit to stand trial and 82% were found criminally responsible. Factors significantly associated with being found fit to stand trial and criminally responsible following the forensic psychiatric observation were: male gender, having received a tertiary education, employment prior to the offence, earning a salary of more than R10 000, having no previous psychiatric or medical illness, a positive forensic history, previous intimate partner violence (IPV) perpetration, indicating a motive for the homicide, having no psychiatric illness at the time of the offence which would impact fitness to stand trial and criminal responsibility.Factors significantly associated with being found not fit to stand trial and not criminally responsible following the forensic psychiatric observation were: female gender, having received a primary education, unemployment prior to the offence, having a previous psychiatric or medical illness, no forensic history, no previous IPV perpetration, not indicating a motive for the homicide, having a psychiatric illness at the time of the offence which would impact fitness to stand trial and criminal responsibility.Conclusion: The characteristics highlighted in this study can contribute to the development of risk assessment tools which can be used to identify likely perpetrators of IPH. Other interventions, for example controlling access to knives and firearms, reducing substance abuse and improving mental health services, are also important in the prevention of IPH.