Accountable or not accountable: A profile comparison of alleged offenders referred to the Free State Psychiatric Complex Forensic Observation Ward in Bloemfontein from 2009 to 2012

Abstract

BackgroundThe crime rate in South Africa is extraordinarily high. The problem of crime is further complicated when a person, who suffers from a mental illness, becomes involved in a crime. Furthermore, the forensic evaluation of a person suspected of having a mental illness involved in alleged criminal behaviour can be challenging. However, a dearth of information exists in South African literature regarding the link between crime and mental illness.AimTo determine the percentage of alleged offenders, referred to the Free State Psychiatric Complex (FSPC) for observation, found accountable and not accountable, and to compare the biographical, diagnosis and offence profiles of these two groups. The analysis of differences can contribute to a better understanding of the complex process of forensic assessments.SettingForensic Observation Ward, FSPC, Bloemfontein.MethodsIn this comparative, retrospective study, all 505 trial-awaiting alleged offenders (observati) referred from 2009 to 2012 for a 30-day observation period, according to Sections 77 and/or 78 of the Criminal Procedures Act, were included. Results were summarised as frequencies and percentages, and means or percentiles. Significant differences between the groups were determined by sample t-tests or chi-squared tests.ResultsObservati found not accountable were in the majority (64.5%). Significant differences were found regarding marital and employment status, substance abuse, type of offence and diagnoses between the two groups. Almost all of the observati found to be not accountable were diagnosed with mental illness at the time of the assessment, whereas most observati found to be accountable for their actions at the time of the alleged offence were not found to be mentally ill. Observati found not accountable were significantly more likely to be diagnosed with schizophrenia, intellectual disability and substance-induced psychotic disorder, and committed mostly assault, murder and vandalism. Observati found accountable committed mostly rape, murder and theft.ConclusionThe majority of observati were found not accountable, with significant differences found between the two groups regarding demographic characteristics, type of diagnosis and offences committed. The identified differences can be used to assist in establishing criteria for the appropriate referral of alleged offenders by courts. Unnecessary referrals have a serious financial impact on the Department of Health. Furthermore, the high incidence of substance abuse among persons referred to the FSPC highlights the need for more substance rehabilitation centres in the Free State Province.

The profile of suspected criminal offenders referred for psychiatric evaluation on an outpatient basis at Ngwelezana Hospital

“…The majority of suspected criminal offenders assessed in this study were male (95.65%), single, unemployed and had a lower level of education, which is similar to other local outpatient and inpatient studies. 9 , 10 , 11 , 16 The median age in this study was 29 years, similar to other studies; for example, Zapf et al’s study found a median age of 33 years, 17 Calitz et al of 30 years 16 and Marais et al of 32 years. 8 The demographic profiles seen on an outpatient basis appears to be in keeping with those observed on an inpatient basis in both local and international studies.…”

“… 23 The assessment of these individuals must take into account the range of social, cognitive, behavioural and communicative characteristics of the assessee. 24 Studies in KZN found a higher prevalence of individuals with intellectual disability (22.7% in this study and 36.26% in the study by Houdi 10 ) compared with studies in other provinces (19% in the study by Ndala 11 and 20.1% in the study by Du Plessis 9 ). This indicates a gap in addressing the needs of this population in communities to prevent high levels of offending behaviour, as well as the proper diversion and rehabilitation of individuals with intellectual disability.…”

“…Few studies have reported on such assessments in South Africa, with most assessments being carried out on an inpatient basis, 8 , 9 , 10 those being conducted on a preliminary outpatient basis having taken place in rural, under-resourced settings. 6 , 11 A number of countries have explored the option of outpatient forensic observations, including Israel, where Olmer found that in 65.2% of the court-ordered psychiatric assessments, the assessing psychiatrist felt that there was no need for hospitalisation or inpatient forensic assessment.…”

Mental health of people detained within the justice system in Africa: systematic review and meta-analysis

“…42% fulfilled SCAN criteria for current depression disorder diagnosisLowBarrett et al 2007 [52]PrevalenceForensic wardSouth AfricaNCensusYes, No71, NS, 94.4%Psychiatric referralsNC *Detained “state patients” accused but found unfit to stand trial or not responsible, referred to forensic wardPsychiatric record (D)Schizophrenia (35.2%), mental retardation (22.5%) and psychoses other than schizophrenia (11.3%) most prevalent, followed by bipolar disorder (5.6%). 84.5% not able to stand trial and not accountable; 7% not fit to stand trial and accountable; 8.5% not accountable and fit to stand trialMediumBuchan 1976 [104]PrevalenceForensic wardZimbabweNCensusNo, No256, NS, NSPsychiatric referralsU *Referrals to hospitalPsychiatric record (D)Prevalence of schizophrenia 44%; epilepsy 22%HighCalitz et al 2006 [105]PrevalenceForensic wardSouth AfricaNCensusYes, No514, 30 (median), 94.6%Psychiatric referralsNC/A *Awaiting trial, referrals to hospitalPsychiatric record (D)46% psychiatric prevalence.Mediumdu Plessis et al 2017 [106]PrevalenceForensic wardSouth AfricaNCensusYes, No505, NA, 94%Awaiting trial; psychiatric referralsNC/A *Awaiting trial, referrals to hospitalPsychiatric record (D)Those not accountable significantly more likely to have mental illness (p = 0.0001) and be diagnosed with schizophrenia (p = 0.0001), intellectual disability (p = 0.0001), and substance-induced psychotic disorder (p = 0.02) than those not accountable. 98% of those found not accountable had mental illness.…”

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

“…18 , 19 Other published studies that have been previously conducted in South Africa on offenders referred by courts for psycho-legal evaluation under the CPA have either been confined to single sites, with relatively small sample sizes, or have focused primarily or exclusively on male offenders. 20 , 21 , 22 , 23 , 24 , 25 …”