Forensic telepsychiatry : a possible solution for South Africa?

Abstract

Objective: South Africa has a shortage of facilities and psychiatrists to assess adjudicative competence of prisoners awaiting assessment under sections 77 to 79 of the Criminal Procedures Act of 1977. Various solutions have been proposed by the Department of Health. The recent linking of a Magistrate's court and a prison by videoconferencing offers the opportunity to implement a forensic telepsychiatry service. The literature on forensic telepsychiatry for assessment of adjudicative competence was reviewed. Method: The electronic databases, PubMed, Scopus, Cinahl and Google Scholar were searched for papers on forensic telepsychiatry. The inclusion criterion was papers reporting the use of videoconferencing for assessment of adjudicative competence or for assessment for referral out of the judicial system, by psychiatrists or psychologists. Results: 411 papers were found of which 13, published between 1997 and 2008 were relevant. The use of videoconferencing for forensic psychiatric assessment was reported from four countries. The courts in those jurisdictions have accepted the use of videoconferencing for assessment and no successful appeals have been mounted on the basis of the use of videoconferencing for assessment. User satisfaction has not been reported for assessing adjudicative competence. Forensic telepsychiatry has been found to be cost effective, improve access to scarce specialist skills and reduce transport of prisoners under guard to hospitals or psychiatrists to prisons. Conclusion: There is nothing in the literature to suggest that a forensic telepsychiatry service is not feasible in South Africa and a pilot project is being planned.

Telepsychiatry: effectiveness and feasibility

“…56,71,72 In addition, a recent review summarized how in Australia, Canada, the United Kingdom, and the United States, telepsychiatry has been used for assessments of fitness to stand trial, or adjudicative competence. 73 This review highlighted how telepsychiatry has been particularly used in Australia for the purposes of identifying potentially mentally ill offenders who might benefit from court diversion or pretrial psychiatric assessment. 73 To date, there has been limited application of telepsychiatry to provide cross-border mental health care and minimal research in low and middle income countries.…”

“…73 This review highlighted how telepsychiatry has been particularly used in Australia for the purposes of identifying potentially mentally ill offenders who might benefit from court diversion or pretrial psychiatric assessment. 73 To date, there has been limited application of telepsychiatry to provide cross-border mental health care and minimal research in low and middle income countries. 74 Synchronous telepsychiatry requires specific technology which may limit its application where power sources are unreliable or where land-based telephone and Internet services are lacking.…”

Telepsychiatry in actual practice - State of the art according to literature

“…In the field of the rapidly development technologies, in the last several decades, there are some newly developed patient related activities which could be called telehealth or telemedicine, without a clear distinction between those two terms 1,2,3 .…”

The role of digital communication in patient–clinician communication for NHS providers of specialist clinical services for young people [the Long-term conditions Young people Networked Communication (LYNC) study]: a mixed-methods study

“…A review of forensic telepsychiatry in mental illness 351 reported that health-care staff were less satisfied with using videoconferencing than the prisoners they were treating. Martin et al, however, found that clinicians prefer e-mail and web-based approaches.…”

“…Mars et al 351 and Shore 358 provide limited details of included studies' characteristics, such as clinical outcomes and participants' demographics. Although McGeary et al 352 searched for grey literature, they excluded it later without giving any reasons.…”