Abstract
AimsThis study examines common factors associated with recidivism among state patients at a South African forensic psychiatric hospital. More specifically, demographic, clinical and criminological factors of a recidivist group are compared to a non-recidivist group with the intention of understanding to what extent these factors might determine the likelihood of re-offending.MethodA retrospective case file review of 293 inpatients and a random selection of 120 outpatients was conducted. For the purpose of the study, a patient was classified as a recidivist if an additional charge or act of violence was added to the file while the patient was on leave of absence in the community. Of the inpatients, only those who met the criteria for recidivism were included in the study. All 120 randomly selected outpatients were included. Demographic, clinical and criminological data were captured for all patients.ResultsEighty recidivists were compared with 100 non-recidivists. Using the × 2 and Fischer’s exact test, substance-use disorder, antisocial personality disorder, an index offence of assault and in-ward adverse events were found to be associated with recidivism (p < 0.05). Using logistic regression analysis, the odds of recidivism in a patient with an index offence of assault was 8.4 times of those who did not commit assault as an index offence (95.0% CI 1.6–43.1). The odds of recidivism for patients with cannabis use was 2.8 (95.0% CI 1.3–6.0) and for patients with in-ward adverse sexual behaviour was 17.2 (95.0% CI 2.0–150).ConclusionSubstance-use disorder and antisocial personality disorder are associated with higher risk for recidivism. This study also highlights that a less serious offence such as assault had a higher association with recidivism. Patients noted to display adverse sexual behaviour in the ward pose a potentially high risk for re-offence. Important criminal history factors and certain clinical factors could not be interpreted because of large amounts of missing data in patients’ files.
Highlights
The South African criminal justice system requires that all mentally disordered offenders (MDOs) who commit a serious or violent offence receive an evaluation by a forensic psychiatric unit
This study examines common factors associated with recidivism among state patients at a South African forensic psychiatric hospital
Substance-use disorder and antisocial personality disorder (ASPD) are associated with higher risk for recidivism
Summary
The South African criminal justice system requires that all mentally disordered offenders (MDOs) who commit a serious or violent offence receive an evaluation by a forensic psychiatric unit. The 30-day assessment period is conducted by forensic psychiatrists and a multidisciplinary team. A report is compiled regarding the suspected MDO’s fitness to stand trial and his or her criminal capacity at the time of the alleged offence. In cases where the alleged perpetrator was determined to be unfit for trial and/or not criminally responsible because of the presence of a mental illness, the MDO is most likely to be declared a ‘state’ patient and diverted out of the criminal justice system to a forensic psychiatric facility for the purposes of care, treatment and rehabilitation.[1] Within this system, forensic psychiatric teams are faced with the difficult task of risk assessment and managing repeat offenders. ‘A recidivist is one who after release from custody for having committed a crime [...] falls back, or relapses into former behaviour patterns and commits additional crimes’.3
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