The profile of suspected criminal offenders referred for psychiatric evaluation on an outpatient basis at Ngwelezana Hospital

Background: Some suspected criminal offenders in South Africa are required to undergo forensic psychiatry assessments before or during the trial, which can be delayed as a result of the shortage of psychiatrists and inpatient forensic psychiatry beds. In KwaZulu-Natal (KZN) province, only one hospital (Fort Napier Hospital [FNH]) is designated for the 30-day inpatient forensic psychiatry assessments and there is a long waiting list for suspected criminal offenders awaiting assessment. There is a need to find ways of alleviating the backlog in the waiting list, with the use of outpatient forensic assessments being a possible adjunctive method. Aim: To determine the demographic, clinical and forensic profile of suspected criminal offenders referred for outpatient preliminary assessment to Ngwelezana Hospital, and identify the profile of those who most likely require referral to FNH for a 30-day inpatient assessment. Setting: The study was conducted at Ngwelezana Tertiary Hospital, in KZN, South Africa. Methods: We conducted a retrospective chart review of 207 suspected criminal offenders referred for outpatient forensic assessment from January 2009 to June 2015. Results: The majority of the participants were males (94.2%), with a diagnosis of substance use disorder (28.2%), intellectual disability (23.4%) or psychotic disorders (21.8%). Forty three per cent were charged with sexual crimes and 10.7% with murder. Fifty seven per cent were recommended for referral to FNH for a 30-day inpatient forensic assessment, whilst 43% were not recommended for referral. Those recommended for inpatient assessment were significantly more likely to have a lower level of education ( p = 0.02), to be on a disability grant ( p < 0.01), and to have been diagnosed with intellectual disability ( p < 0.01), than those not recommended for referral. Conclusion: Identifying the characteristics of suspected criminal offenders who are most likely to be recommended for referral to FNH will potentially reduce the number of unnecessary referrals.