The 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.
To 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.
Forensic Observation Ward, FSPC, Bloemfontein.
In 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
Observati 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.
The 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.
A high crime rate has a detrimental effect on the social well-being of a society. The problem is further complicated when a person suffering from a mental illness becomes involved in crime. Mental illness may deprive persons of the capacity to appreciate the unlawfulness of their conduct.
South African courts can request an evaluation of the mental state of a person charged with committing a crime to determine whether the individual has any current mental problem that would interfere with his or her ability to participate in court proceedings.
The researchers sought to determine the percentage of alleged offenders referred to the FSPC for observation from January 2009 to December 2012, found accountable and not accountable, and to compare the biographical, diagnosis and offence profiles of these two groups.
Accountability – according to Section 78 (accountability) of the
Observati – refers to the alleged offenders who are sent to a designated psychiatric facility for a 30-day observation period, according to Sections 77 and/or 78 of the
This was a comparative, retrospective study.
Forensic Observation Ward, FSPC, Bloemfontein.
All trial-awaiting alleged offenders (henceforth referred to as observati), sent to the Forensic Observation Ward of the FSPC from January 2009 to December 2012 (± 100 patients admitted per year) for a 30-day observation period in terms of Sections 77 and/or 78 of the Criminal Procedures Act, were included in this study.
The study was approved by the Ethics Committee, Faculty of Health Sciences, University of the Free State. Permission to collect and analyse the data was obtained from the Chief Executive Officer of the Free State Psychiatric Complex (FSPC). None of the files was removed from the premises of the FSPC. The names of the observati were not recorded on the data forms, and all results and information were handled confidentially.
No observations were excluded.
None.
Data were captured on a self-compiled data form, and included relevant information from clinical records and psychiatric reports. The forms were completed by the researchers in pairs to lower the risks of transcription errors.
A pilot study was conducted by randomly selecting 10 files from the FSPC Forensic Observation Ward. These files were evaluated for completeness and utility to identify and eliminate possible problems. All the files used in the pilot study were included in the main study.
Data were analysed by the Department of Biostatistics, Faculty of Health Sciences, University of the Free State (UFS). The results were summarised as frequencies and percentages (categorical variables), and means or percentiles (numerical variables). Independent sample
After the 30-day observation period at the FSPC Forensic Observation Ward, the multidisciplinary team found almost two-thirds (64.6%) of the 505 observati unaccountable (
Outcomes of the observati after the 30-day observation period.
Outcome | Total study population ( |
|
---|---|---|
% | ||
Accountable | 169 | 33.5 |
Not accountable | 326 | 64.6 |
Unknown | 10 | 2.0 |
The majority of the observati in both groups (> 94%) were men (
Socio-demographic data of observati at the time of the offence.
Variable | Accountable | Not accountable | |||
---|---|---|---|---|---|
% | % | ||||
9–19 | 16 | 9.5 | 15 | 4.6 | |
20–29 | 58 | 34.3 | 139 | 43.0 | |
30–39 | 48 | 28.4 | 90 | 27.9 | |
40–49 | 24 | 14.2 | 56 | 17.3 | |
50–59 | 14 | 8.3 | 15 | 4.6 | |
60–69 | 5 | 3.0 | 6 | 1.9 | |
> 70 | 4 | 2.4 | 2 | 0.6 | |
Afrikaans | 20 | 12.3 | 27 | 8.7 | |
English | 4 | 2.5 | 4 | 1.3 | |
Sotho | 123 | 75.5 | 247 | 79.9 | |
Zulu | 1 | 0.6 | 5 | 1.6 | |
Tswana | 9 | 5.5 | 12 | 3.9 | |
Xhosa | 5 | 3.1 | 14 | 4.5 | |
Bangli | 1 | 0.6 | 0 | 0 | |
Male | 160 | 94.7 | 308 | 94.5 | |
Female | 9 | 5.3 | 18 | 5.5 | |
Married | 16 | 10.2 | 18 | 5.9 | |
Single | 121 | 77.1 | 272 | 88.9 | |
Divorced | 5 | 3.2 | 5 | 1.6 | |
Living together | 11 | 7.0 | 8 | 2.6 | |
Other | 4 | 2.6 | 3 | 1.0 | |
Employed | 49 | 29.9 | 35 | 11.2 | |
Unemployed | 79 | 48.2 | 175 | 55.7 | |
Disability grant | 28 | 17.1 | 90 | 28.7 | |
Scholar | 3 | 1.8 | 6 | 1.9 | |
Pensioner | 5 | 3.1 | 7 | 2.2 | |
Vendor | 0 | 0 | 1 | 0.3 |
Statistically significant differences in the marital and employment statuses were found between the two groups. More than three-quarters (77.1%) of observati found accountable were single compared with 88.9% of observati found not accountable.
Only 11.2% of non-accountable observati were employed compared with 29.9% of observati found accountable. At least 70.0% of observati in both groups were unemployed (which include observati receiving disability grants, scholars and pensioners).
According to
History of substance abuse and the substance use of the observati at the time of the offence.
Variable | Accountable | Not accountable | |||
---|---|---|---|---|---|
% | % | ||||
Yes | 98 | 66.2 | 207 | 68.3 | |
No | 50 | 33.8 | 96 | 31.7 | |
None | 29 | 30.9 | 47 | 33.6 | 0.66 |
Alcohol | 42 | 44.7 | 47 | 33.6 | 0.09 |
Cannabis | 12 | 12.8 | 29 | 20.7 | 0.12 |
Alcohol + cannabis | 7 | 7.5 | 14 | 10.0 | 0.50 |
Cannabis + glue | 1 | 1.1 | 2 | 1.4 | 1.00 |
Glue | 2 | 2.1 | 0 | 0 | 0.16 |
Alcohol + cocaine | 1 | 1.1 | 0 | 0 | 1.00 |
Alcohol + cannabis + glue | 0 | 0 | 1 | 0.7 | 0.40 |
, Fisher’s exact tests were used because of small numbers.
Of those with available data (53.3%), 65 of the 94 (69.1%) observati found accountable and 93 of the 140 (66.4%) observati found not accountable were under the influence of some kind of substance at the time the offences were committed. In both groups, alcohol was the substance most used at the time of the offence (accountable observati = 44.7% and not accountable observati = 33.6%). A higher percentage (20.7%) of observati found not accountable used cannabis compared with 12.8% of observati found accountable. Offences committed by the observati against persons and property are summarised in
Offences committed by observati against persons.
Offence committed against persons | Accountable ( |
Not accountable ( |
|||
---|---|---|---|---|---|
% | % | ||||
Murder | 37 | 21.9 | 32 | 9.8 | < 0.01 |
Attempted murder | 15 | 8.9 | 12 | 3.7 | 0.02 |
Assault | 21 | 12.4 | 113 | 34.7 | < 0.0001 |
Rape | 64 | 37.9 | 69 | 21.2 | < 0.0001 |
Attempted rape | 5 | 3.0 | 21 | 6.4 | 0.10 |
Sexual offences other than rape | 5 | 3.0 | 8 | 2.5 | 0.77 |
Sodomy | 0 | 0 | 1 | 0.3 | 1.00 |
Contravention of protection order | 3 | 1.8 | 12 | 3.7 | 0.24 |
Fraud | 6 | 3.6 | 1 | 0.3 | 0.01 |
Dealing with dagga | 1 | 0.6 | 0 | 0 | 0.34 |
Child abuse | 1 | 0.6 | 0 | 0 | 0.34 |
Domestic violence | 1 | 0.6 | 2 | 0.6 | 1.00 |
Defeating the end of justice | 1 | 0.6 | 0 | 0 | 0.34 |
Conspiracy to commit murder | 1 | 0.6 | 0 | 0 | 0.34 |
Intimidation | 1 | 0.6 | 1 | 0.3 | 1.00 |
Resisting arrest | 1 | 0.6 | 0 | 0 | 0.34 |
Culpable homicide | 2 | 1.2 | 1 | 0.3 | 0.27 |
Concealment of birth | 0 | 0 | 1 | 0.3 | 1.00 |
, Fisher’s exact tests were used because of small numbers.
Offences committed by observati against properties.
Offence against property | Accountable ( |
Not accountable ( |
|||
---|---|---|---|---|---|
% | % | ||||
Vandalism | 7 | 4.1 | 34 | 10.4 | 0.02 |
Theft | 20 | 11.8 | 31 | 9.5 | 0.42 |
Burglary | 14 | 8.3 | 32 | 9.8 | 0.58 |
Robbery | 14 | 8.3 | 5 | 1.5 | < 0.01 |
Arson | 1 | 0.6 | 8 | 2.5 | 0.18 |
Possession of suspected stolen property | 1 | 0.6 | 0 | 0 | 0.34 |
Fraud, forgery and uttering | 1 | 0.6 | 0 | 0 | 0.34 |
Bestiality | 0 | 0 | 1 | 0.3 | 1.00 |
Trespassing | 0 | 0 | 4 | 1.2 | 0.31 |
, Fisher’s exact tests were used because of small numbers.
The most common offences committed against persons by observati found accountable were rape (37.9%) and murder (21.9%). Assault (34.7%) and rape (21.2%) were the most common offences committed against persons by observati found not accountable. In observati found accountable, 43.8% committed sexual offences compared with the 30.4% observati found not accountable.
Statistically significant differences were seen in the main offences committed against persons by the two groups. Observati committing sexual offences, including rape, were mostly found accountable.
Theft (11.8%) was the most common offence committed against properties by observati found accountable. For observati found not accountable, vandalism (10.4%) was the top offence. Statistically significant differences were noted for vandalism and robbery. The diagnoses of observati found accountable and not accountable are shown in
Diagnoses of the observation.
Diagnosis | Accountable ( |
Not accountable ( |
|||
---|---|---|---|---|---|
% | % | ||||
No mental illness | 92 | 63.0 | 6 | 2.0 | 0.0001 |
Schizophrenia | 15 | 10.3 | 193 | 63.3 | 0.0001 |
Mental retardation | 5 | 3.4 | 51 | 16.7 | 0.0001 |
Bipolar mood disorder | 6 | 4.1 | 11 | 3.6 | 0.79 |
Psychosis due to a general medical condition | 3 | 2.1 | 16 | 5.2 | 0.11 |
Psychosis due to epilepsy | 2 | 1.4 | 5 | 1.6 | 0.83 |
Substance-induced psychotic disorder | 4 | 2.7 | 26 | 8.5 | 0.02 |
Delirium | 0 | 0 | 2 | 0.7 | 1.00 |
Personality disorder | 2 | 1.4 | 0 | 0 | 0.10 |
Dementia | 6 | 4.1 | 8 | 2.6 | 0.40 |
Amnesia | 2 | 1.4 | 0 | 0 | 0.10 |
Folic acid deficiency | 0 | 0 | 1 | 0.3 | 1.00 |
Epilepsy | 5 | 3.4 | 8 | 2.6 | 0.76 |
Axis 2 personality disorder | 1 | 0.7 | 0 | 0 | 0.32 |
Post-traumatic stress disorder | 2 | 1.4 | 1 | 0.3 | 0.25 |
Psychosis | 3 | 2.1 | 15 | 4.9 | 0.15 |
Frontal lobe syndrome + epilepsy | 0 | 0 | 1 | 0.3 | 1.00 |
Conduct disorder | 0 | 0 | 1 | 0.3 | 1.00 |
Major depressive disorder | 0 | 0 | 1 | 0.3 | 1.00 |
Psychotic disorder | 0 | 0 | 1 | 0.3 | 1.00 |
Temporal lobe epilepsy | 0 | 0 | 1 | 0.3 | 1.00 |
Pseudologia fantastica factitious disorder | 0 | 0 | 1 | 0.3 | 1.00 |
, Diagnosis was not traceable in 23 and 21 of the observation per group, respectively.
, Fisher’s exact tests were used because of small numbers.
Nearly two-thirds (63.0%) of the observati found accountable had no mental illness, compared with only 2.0% of observati found not accountable (95% CI for difference 52.7% – 68.5%). Statistically significant differences for schizophrenia, mental retardation and substance-induced psychotic disorder were found between the two groups. The majority (63.3%) of observati found not accountable were diagnosed with schizophrenia compared with 10.3% of observati found accountable. Mental retardation was diagnosed in 16.7% of observati found not accountable compared with only 3.4% of observati found accountable.
At the time of the offence, 38.5% of observati found accountable and 28.5% of observati found not accountable were under the influence of a substance. In our study population, 31 observati were diagnosed with substance-induced psychotic disorder, of which 4 (2.7%) were found accountable and 26 (8.5%) were found not accountable.
Almost two-thirds (64.5%) of the observati at FSPC were found unaccountable. This is lower than the 80% found by Strydom et al.,
The majority of the observati in both groups were men. Similar percentages were reported by Douglas et al.
Race was not always recorded in the files, and the researchers used language as a variable to get insight into the race distribution of the observati. More than three-quarters of the observati in both groups were Sotho-speaking. Strydom et al.
Significantly more observati found not accountable were single. The majority of participants studied by Douglas et al.
Most (70.0%) of the observati were unemployed. The percentage of employed observati in the non-accountable group was much lower than the percentage in the accountable group. Strydom et al.
About two-thirds of both groups reported a history of substance abuse; however, there was no significant difference between the two groups. The results are similar to findings of Verster and Van Rensburg
In more than half of the cases, substance abuse at the time of the offence was not reported. This can be problematic when the accountability versus not accountability comes into play, seeing that the substances used at the time of the offence may play a major role in determining the observati’s mental state at that time, and thus the accountability of the observati. Alcohol was the primary substance used at the time of the offence, followed by cannabis. Mosotho et al.
Observati found accountable mostly committed rape and murder, whereas assault and rape were the most common offences committed by observati found not accountable. This is in line with findings by Strydom et al.
Observati committing sexual offences were typically found accountable. This was also true to a lesser extent for murder and attempted murder. Joubert and Van Staden
Almost all of the observati found not accountable had a mental illness diagnosis. In contrast, most observati found accountable did not have any mental illness. Similar results were reported by Gagiano et al.
Observati found not accountable were significantly more likely to be diagnosed with schizophrenia, mental retardation and substance-induced psychotic disorder. Similar findings were reported by Slabber et al.
In the time span from 2009 to 2012, 505 observati were sent by the court for observation to the FSPC Forensic Observation Ward. After the 30-day observation period, 64.5% were found not accountable, whereas 35.5% were found accountable.
Socio-demographically, the two groups were similar with regard to age, home language and gender distribution. Observati found not accountable were more likely to be single and unemployed than observati found accountable. In both groups, the majority of observati had a history of substance abuse. This confirms that, regardless of the presence of mental illness, substance abuse is still a major factor in violent and criminal behaviour in South Africa.
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. Mental conditions such as schizophrenia, mental disability and psychosis may deprive, even though not necessarily, persons of the capacity to appreciate the unlawfulness of their conduct. It may also deprive them of the capacity to control their conduct. It is not surprising that all of the persons found not accountable suffered from the symptoms of one or more of these conditions at the time of the offence. The high incidence of serious offences such as assault, murder and rape among this sample supports the notion that the incidence of serious offences in South Africa is on the rise.
There were significant differences in the two groups regarding marital status, employment status, offences against persons, offences against property and diagnosis. However, more research is needed to make definitive conclusions.
Although this study provided noteworthy findings, the results should be interpreted with care, especially as far as their generalisation is concerned. Only observati at the FSPC, and therefore from its catchment area, were included in the study. Furthermore, not all the possibly mentally ill observati were referred by the courts for observation. Some of the files were incomplete with important data missing. Nevertheless, this study contributes important data regarding demographics, psychiatric diagnoses and offence profiles in the field of forensic psychiatry.
We would like to thank the nursing staff at the Forensic Observation Ward of the Free State Psychiatric Complex as well as the Social Works Department for the use of their files. We also thank Ms T. Mulder, Medical Editor, School of Medicine, University of the Free State, for technical and editorial preparation of the manuscript.
The authors declare that they have no financial or personal relationships which may have inappropriately influenced them in writing this article.
H.d.P., H.N., I.O., S.v.d.M. and S.Z. developed the protocol, performed the data collection and did the initial write up of this study. E.d.P. was the supervisor of this study; conceptualised the idea; and assisted with the protocol development, data collection and interpretation of data, and write up of this study. G.J. assisted with the planning, performed the data analysis and assisted with the interpretation and write up of this study.