Psychiatric evaluation of offenders referred to the Free State Psychiatric Complex according to sections 77 and / or 78 of the Criminal Procedures Act

In South Africa a defendant can be referred during a trial for 30 days of psychiatric observation to assess whether he/she has a mental illness or defect in terms of section 79(2) of the Criminal Procedures Act (Act 51 of 1977). This may result in the accused being considered unfit to stand trial (section 77), or being deemed ‘incapable of appreciating the wrongfulness of his act; or of acting in accordance with the appreciation of the wrongfulness of his act’ (section 78). When it appears that an accused is not triable or accountable, the accused is referred for psychiatric observation to a hospital for the mentally ill or to another institution as indicated by the court (section 79(3)). In the Free State offenders are referred to the Psychiatric Complex in Bloemfontein.

The increase in crime is a problem of great concern in South Africa and complications arise when the accused is mentally ill.Although it is widely accepted that a close relationship exists between mental illness and crime, only a few South African studies have been published on this subject. 1 South Africa a defendant can be referred during a trial for 30 days of psychiatric observation to assess whether he/she has a mental illness or defect in terms of section 79(2) of the Criminal Procedures Act (Act 51 of 1977).This may result in the accused being considered unfit to stand trial (section 77), or being deemed 'incapable of appreciating the wrongfulness of his act; or of acting in accordance with the appreciation of the wrongfulness of his act' (section 78).When it appears that an accused is not triable or accountable, the accused is referred for psychiatric observation to a hospital for the mentally ill or to another institution as indicated by the court (section 79(3)). 2 In the Free State offenders are referred to the Psychiatric Complex in Bloemfontein.
A study conducted in Finland 3 found that men diagnosed with a mental illness had a 4 times higher risk of committing violent crimes than men without a mental disorder.For women with a serious mental illness the chances were 27 times higher.Substance abuse increases the possibility of violent crimes.In a similar study Verster and Van Rensburg 4 found that 77% of offenders charged with murder had a history of substance abuse and 36% a history of cannabis abuse.
According to Vielma et al. 5  Several studies 4,[11][12][13][14][15] have been conducted to highlight tendencies with regard to triability and accountability.The percentage of offenders found to be not triable ranged between 1.2% 13 and 77%. 15Cohrane et al. 12 found that 12% of 1 710 accused were unaccountable.Verster and Van Rensburg 4 found that 32.5% of the offenders charged with murder were unaccountable.

Objective
The aim of the study was to analyse offenders referred to the

Study design and population
A descriptive, retrospective study was undertaken.
The sample consisted of 514 awaiting-trial offenders from the Free State referred to the Psychiatric Complex for 30 days of psychiatric observation, according to sections 77 and/or 78 of the Criminal Procedures Act, from 1995 to 2001.The reason for their referral was the possibility that they were not triable or accountable.

Measurement
The multi-professional team of the forensic unit at the Free State Psychiatric Complex included a psychiatrist, a registrar in psychiatry, a social worker, a clinical psychologist, a psychiatric professional nurse, an occupational therapist, a neurologist and a juror.
During the 30 days of observation the accused undergoes several assessments regarding his/her physical and mental condition.The evaluation includes several psychiatric interviews, psychological tests, physical examination, psychosocial report and evaluation of the facts of the case.On admission the accused is examined physically.Thereafter the person is evaluated at least once a week using a structured psychiatric interview.The interview centres around the clinical picture, psychosocial background, the individual's account of the crime, and his/her ability to understand court proceedings.When needed, translators are Nearly half the offenders (48.6%) were found to be triable and accountable, whereas 40.3% were found to be untriable and unaccountable, 4.9% were found to have diminished accountability, and 3.5% were found to be unaccountable.

Conclusion and recommendations
The majority of the offenders were found to be mentally sound, triable and accountable, and were referred back to the courts.
This results in high costs for the Department of Health.To reduce the high rate of unnecessary referrals it is recommended that the courts give clear reasons for the referrals according to each section (77 and 78).
The results of the study also highlight the problem of the mentally handicapped person involved in crime.The reason for this finding seems to be the shortage of supervision, care and rehabilitation facilities for the intellectually disabled.
A significant number of the referred offenders were first diagnosed as being mentally ill only after the crime was committed.One of the reasons might be the fact that some people with psychiatric disorders are not known to and have not been identified by the mental health system.It is therefore of the utmost importance to implement a comprehensive psychiatric community service.
The most worrying finding of the study is the role of alcohol and cannabis in crime.Serious attention must be given to the management and correction of this situation.

Free
State Psychiatric Complex from 1995 to 2001 according to sections 77 and or 78 of the Criminal Procedures Act (Act 51 of 1977).The specific aims were to: (i) investigate the socio-demographic characteristics of the offenders; (ii) summarise the findings regarding accountability and triability; and (iii) identify the most common psychiatric conditions associated with crime.

Psychiatric evaluation of offenders referred to the Free State Psychiatric Complex according to sections 77 and/or 78 of the Criminal Procedures Act
Psychiatric Complex from 1995 to 2001 according to section 77 (triability) and/or section 78 (accountability) of the Criminal Procedures Act (Act 51 of 1977).Method.The study population consisted of 514 persons awaiting trial in the Free State.They were referred to the Free State Psychiatric Complex for 30 days' observation from 1995 to 2001.A data form was created and used to transfer the relevant information from the accused's clinical files.Data analysis.The data collected were analysed by the Department of Biostatistics at the University of the Free State.(18.1%) and rape (16.2%).The most common mental disorder diagnosed was schizophrenia (23.0%), with 54.3% having no mental disorder.Nearly half the offenders (48.6%) were found to be triable and accountable.articlesVolume 12 No. 3 September 2006 -SAJPTable I summarises the results of similar studies 4,8-10 conducted in South Africa.It is clear that only a few local studies have been published on this subjects.The percentage of offenders found to be mentally ill has ranged between 42% and 57%; most were diagnosed with schizophrenia, followed by mental retardation and epilepsy.