Forensic state patients at Sterkfontein Hospital: A 3-year follow-up study

Abstract

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.