The forensic mental health profile of women offenders in the Eastern Cape, South Africa

Introduction There is a dearth of research on mental health issues in women offenders in South Africa, especially regarding their socio-demographic backgrounds, offence characteristics, and forensic mental health profiles. Objectives This study examined the psychosocial and forensic mental health profile of women offenders referred by eastern Cape courts for forensic evaluation. A range of socio-demographic, criminological, clinical and forensic mental health variables were systematically explored. Methods A bi-phasic, mixed methods study design was adopted. The clinical and forensic records of all women referred for forensic evaluation to Fort England forensic psychiatric hospital in the Eastern Cape, South Africa were retrospectively reviewed, comprising 173 individual cases in the study period of 1993-2017. Inferential statistical analyses (chi-squared and multivariate logistic regression) were applied to explore relationships between variables and offending outcomes of nterest. Detailed semi-structured interviews were subsequently conducted with a sub-sample of 8 women with mental disorder and violent offending ackgrounds. Interview transcripts thematically analysed. Results Most women came from impoverished and disadvantaged backgrounds. Whilst the majority were first offenders, a high proportion had violent index offences, with murder, attempted murder and assault with intent to do grievous bodily harm accounting for over half of cases. The majority of victims of violence were well known to the perpetrator, especially as biological children, intimate male partners or close family members. Biological children in their first year of life were particularly vulnerable to being victims of homicidal violence. Disproportionately high rates of pre-offence mental illness, alcohol misuse, HIV infection and prior abuse of the offender (especially by intimate male partners) were present. High rates of severe mental disorders (especially psychiatric comorbidity and psychotic-spectrum disorders), and relatively low rates of personality disorders and substance disorders were diagnosed. The majority of women were declared to lack trial competence and criminal capacity, respectively, following forensic evaluation. Women who had backgrounds of prior abuse themselves had over three mes the odds of subsequent violent offending in general, and almost six times the odds of homicidal offending in particular. Homicidal offences were significantly more commonly committed by women with no prior psychiatric history and no psychiatric comorbidity. Women who committed homicide had over eleven times of killing children as opposed to adults. Women over the age of 30 years, and those without psychiatric comorbidity, were significantly less likely to have killed children. Thematic analysis of interviews emphasized the important roles played by gender, self-image, and mental health in violent offending pathways. Conclusions A complex array of socio-demographic, criminological, clinical and forensic variables interact in women offenders of the Eastern Cape referred by courts for forensic evaluation. Exploration of these factors improves understanding of the broader psychosocial context of female offending, and of the personal experiences of the women themselves. This in turn provides an enhanced gender-focus to guide the progressive changes required in policy, legislative, clinical and research endeavours in this field

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 profiles

From victim to perpetrator to survivor: The psycho-social context of South African women offenders

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. Aim: 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 6 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 illness and alcohol abuse permeating 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 profiles

Adaptation and validation of a computerized neurocognitive battery in the Xhosa of South Africa

Objective: Large-scale studies have revolutionized biomedical research, and neurocognitive tests can help elucidate the biological basis of neuropsychiatric diseases. However, studies have predominantly been conducted in Western settings. We describe the development and validation of a computerized battery (PennCNB) with the Xhosa population of South Africa. Method: Individuals with schizophrenia (n = 525) and a normative comparison group (n = 744) were balanced on age, sex, education, and region. Participants provided blood samples, were assessed psychiatrically, and were administered a PennCNB translation to isiXhosa, including measures of executive functions, episodic memory, complex cognition, social cognition, and sensorimotor speed. Feasibility was examined with test completion rates and input from administrators, and psychometric structural validity and associations with clinical and demographic characteristics were examined. Results: Tests were well tolerated by participants, as >87% had one (or fewer) test missing. Results suggested a similar factor structure to prior PennCNB studies in Western contexts, and expected age and sex effects were apparent. Furthermore, a similar profile of schizophrenia was observed, with neurocognitive deficits most pronounced for executive functions, especially attention, as well as memory, social cognition, and motor speed relative to complex cognition and sensorimotor speed. Conclusions: Results support the feasibility of implementing a culturally adapted computerized neurocognitive battery in sub-Saharan African settings and provide evidence supporting the concurrent validity of the translated instrument. Thus, the PennCNB is implementable on a large scale in non-Western contexts, shows expected factor structure, and can detect cognitive deficits associated with neuropsychiatric disorders. Obtaining valid measures of cognition by nonspecialized proctors is especially suitable in resource-limited settings, where traditional testing is prohibitive. Future work should establish normative standards, test–retest reliability, and sensitivity to treatment

Dementia in developmental disability

This handbook is aimed at clinicians and others who are engaged in caring for ageing adults with developmental disabilities. It is intended to inform understanding, promote assessment, assist in care planning, and especially to improve everyday living for this needy but sadly often neglected group of vulnerable individuals. The authors base their guidance on evidence, focusing on important insights that are likely to be valuable to the clinician interested in the care of the individuals on whose behalf the book has been prepared. A brief general overview of the area is followed by a detailed consideration of dementia in the context of developmental disability, including cause, diagnosis, assessment and natural history, with case examples. The next chapters concentrate on two of the most high–profile of all the major groups of developmental disabilities, with their own unique patterns of ageing: Down syndrome and cerebral palsy. Other less common causal syndromes, and their characteristics with ageing, are then reviewed. This is followed by a detailed guide to drug treatment issues in this group. The final chapter considers wider issues of psychosocial intervention and life planning for the ageing individual with developmental disability

Forensic mental health services: Current service provision and planning for a prison mental health service in the Eastern Cape

CITATION: Sukeri, K., et al. 2016. Forensic mental health services: Current service provision and planning for a prison mental health service in the Eastern Cape. South African Journal of Psychiatry, 22(1):1-8, doi:10.4102/sajpsychiatry.v22i1.787.The original publication is available at http://www.sajp.org.zaObjectives: No research data exists on forensic psychiatric service provision in the Eastern Cape, Republic of South Africa. The objective of this research was to assess current forensic psychiatric service provision and utilisation rates at Fort England Hospital. This is important in improving and strengthening the service. A related objective was to develop a model for a provincial prison mental health service. Methodology: This study is a situational analysis of an existing forensic psychiatric service in the Eastern Cape. The design of the study was cross sectional. An audit questionnaire was utilised to collate quantitative data, which was submitted to Fort England Hospital, Grahamstown. A proposed prison mental health service was developed utilising prevalence rates of mental illness among prisoners to calculate bed and staff requirements for an ambulatory and in-patient service. Results: During the study period a total of 403 remand detainees were admitted to the forensic psychiatry division of Fort England Hospital. The average length of stay was 494 days and the bed utilisation rate was determined at 203.54%. We estimate that to provide a provincial prison mental health service to treat psychotic illnesses and major depression the province requires a 52 bedded facility and a total staff complement of approximately 31. Conclusions: Forensic psychiatric services include the assessment, management and treatment of mentally disordered persons in conflict with the law and prisoners requiring psychiatric assessments. The Eastern Cape Province does not have plans or policies to assess and manage mentally ill offenders, resulting in an increased load on available services. We recommend that an inter-departmental task team, which includes Health, Justice and Constitutional Development and Correctional Services, should be established in the province, to develop a strategy to assist in the development of an effective and efficient forensic psychiatric service. This should be driven by the provincial Department of Health.https://www.sajp.org.za/index.php/sajp/article/view/787Publisher's versio