There is no rehabilitation or policy for the nearly 150 mentally ill state patients currently being held in South African prisons, neglected and abused, because of a chronic shortage of psychiatric beds, delayed court trials and non-medical prison staff.
Section 41 of the Mental Health Care Act provides for state patients – people who are unfit to stand trial or found not criminally responsible because of their illness – to receive adequate care at designated mental health facilities.
But two mothers who spoke to Mail & Guardian about their sons’ prison ordeals show that state patients are falling through the cracks, and “treated even worse than sentenced criminals”.
Grim anniversary
When Marie Barton visited her mentally ill son at Grootvlei Prison in the Free State last month, it was on the eve of a grim anniversary: the year he had spent in prison while waiting for a bed at a psychiatric hospital.
Barton, who lives in Riebeeckstad about 210km away, never skips the twice-monthly visits she is allowed with James. “My visits are all that keep him going,” she said.
Each trip costs the pensioner R1 000, the result of steep petrol prices and toll fees.
“Most of the time, we can’t even hear each other because their instruments are not working and the glass is very thick. We can only see and talk to each other through the glass.”
James (37) was arrested for assault in November 2020, four months after his father’s death. He was found not criminally responsible based on a psychiatric evaluation by the Free State Psychiatric Complex, formerly Oranje Hospital, which classified him as schizophrenic.
He was declared a state patient by the court and referred to Oranje but because there was no bed available, he was sent to Grootvlei on 28 October 2021.
There, “he has been kept a prisoner” and “treated even worse than sentenced people”, Barton said, “with no treatment and rehabilitation programme since admission”.
Behind bars
Section 41 of the Mental Health Care Act provides for state patients to receive care, treatment and rehabilitation at designated health establishments, not prisons.
There are 148 state patients in prisons awaiting a bed at state-owned psychiatric hospitals, according to Foster Mohale, spokesperson for the Health Department. The Free State and Northern Cape have the highest number of state patients, a combined 64.
Of the country’s 24 state-owned psychiatric hospitals, only 15 are legally allowed under the Mental Health Care Act to admit state patients. The 15 hospitals have a total of 2 479 beds for state patients.
Singabakho Nxumalo, the communication officer at the Department of Correctional Services (DSC), said the department was working with the Health Department to have all state patients removed from prisons.
State patients require special care, said Nxumalo, and keeping them in prison for a prolonged period “is never ideal”.
‘Prison is breaking my son’
James was meant to spend one night in Grootvlei and then be moved to Oranje.
“The sister (at Grootvlei) told me he was going to be there for a very long time because he is number 51 on the list and there’s no space in Oranje,” Barton said.
James, who had an emergency double bypass in 2013, was put in a cell with 22 other state patients awaiting a bed at Oranje, of whom 15 remain.
Until the COVID-19 ban was lifted, Barton wasn’t allowed to take him food and his health deteriorated. “As a chronic heart patient, his diet is very important because he is not well fed (in prison) and only receives two meals a day.”
Since she has been allowed to bring him nutritious food, there’s been a “phenomenal” difference in his physical appearance. “But although he looks good on the outside, he is emotionally and psychologically not well.
“Prison is breaking him …. The psychiatrist saw him once, after I started to fight because he was not getting his medication.” Barton has lost 16kg and says she feels as if she is having a nervous breakdown. “I miss him terribly. He is suffering and I can’t take it anymore,” she said.
Jails not suitable
Former Constitutional Court judge Edwin Cameron, the inspecting judge for the Judicial Inspectorate for Correctional Services (JICS), said it has always been strongly argued that prisons are not suitable for incarcerating state patients.
“State patients form part of a vulnerable group of inmates and the mental wellness challenges they may face places them at risk and imposes wholly unfair responsibility on the DCS, since specialised care must be provided by DCS.”
He said correctional services officials are not trained medical professionals and there are too few contracted or permanent psychiatrists to deal with the needs of this vulnerable group, adding that psychiatric institutions must be encouraged to change their operational models to increase the admission of state patients.
In many prisons, state patients are incarcerated in overcrowded conditions in prisons and the JICS has made “numerous interventions” to facilitate faster transfers to hospitals. Its Independent Correctional Centre Visitors have dealt with incidents of violence, with some having led to the death of state patients.
Abused in prison
In 2017, Phathiswa Adam took the Health Department to court after her son, a state patient, was imprisoned for about two years while waiting for a bed at a psychiatric hospital.
Adam’s son, who was then 19, is mentally disabled and charged with sexual assault in 2015. After being declared a state patient, he was referred to Fort England Psychiatric Hospital in Grahamstown, but was sent to a prison.
After experiencing abuse in prison, he tried to commit suicide. Adam won the court case and her son was released into her care.
Locked up for three years
Sarie Pretorius’ 27-year-old son Dane, who has paranoid schizophrenia, spent three years in a holding cell at Johannesburg Correctional Centre, commonly known as Sun City, before he got a bed at Sterkfontein Hospital two months ago.
He is now receiving “excellent care”.
“After my son got arrested for assaulting two police officers, I went to the prosecutor and gave him information about my son’s medical history. He suggested the court send my son for an evaluation at Sterkfontein Hospital. He told me there is a waiting list of about five months.”
After evaluation, Dane was found to be psychotic and unfit for trial.
Pretorius was not willing to sign responsibility for Dane because she is afraid of him. “He tried to kill me several times,” she said.
In prison, he shared a holding cell with 50-plus inmates who had been charged for offences including petty theft, murder and rape. “They (state patients) do go for their medicine and eat separately but for the rest of the time, they mix with the other prisoners, putting them in a very vulnerable position,” she said.
During his prison stay, Dane received his medication, but “nothing else”. Pretorius said he became addicted to crystal meth and dagga in jail.
“As a mother, this (prison ordeal) is the worst thing you can go through.” She came close to committing suicide more than once.
“Jail is corrupt. My son costs me between R4 000 and R10 000 a month. Because he is mentally ill, he does not understand the value of money. He kept taking stuff from other prisoners, which I had to pay. I am still paying them off … The guards and the chiefs are all in on it,” she said.
Major concerns
Tando Melapi, who heads the forensic psychiatry unit at Sterkfontein Hospital, said assessments on individuals are conducted by a panel of at least two psychiatrists for serious offences – murder, rape, assault, grievous bodily harm – and by a single psychiatrist for minor offences like damage to property, theft, common assault.
This referral can happen at any stage of the trial before sentencing is completed.
Delays in psychiatric treatment and in the speedy completion of trials are major concerns, said Melapi. “That means that some accused people can wait in prison for long before they are referred. Thus, their ‘waiting in prison’ period may not be only due to lack of beds in hospitals.”
Awaiting trial detainees who do access psychiatric medication in prison generally do not receive any other psychiatric rehabilitative services, including drug addiction rehabilitation.
“For the accused and especially those charged with minor crimes, there exists a possibility that their waiting period [for a bed] is longer than the sentence they will eventually get, if found guilty,” said Melapi.
High suicide rates
Bongani Majola, the chairperson of the Human Rights Commission, said the concerns it raised about state patients in its 2017 report into the status of mental health care, including state patients, “are still relevant today, unfortunately”.
“Our main concerns with this ongoing issue is that it is a violation of a number of fundamental human rights, including the right to dignity, to access healthcare, to equality, and of course the right to freedom and security of the person,” he said.
The lack of forensic mental health infrastructure within the criminal justice system is “unfortunately one symptom of a larger challenge with South Africa’s mental health system”.
The commission’s report recommended the Correctional Services Department must assist the Health Department to ensure no state patients are housed in prisons, finalise the national policy on mental health care in prisons and conduct an inquiry into the high rates of suicide.
“We gave the DCS up to 18 months to implement these recommendations. In November 2021, we requested information from both departments regarding steps taken towards the implementation of the recommendations … We have still not received a response.
“There is still no policy on mental health care in prison systems, and ‘state patients’ continue to be imprisoned.”
See more from MedicalBrief archives:
Mentally ill inmates face Esidimeni scenario — Inspectorate judge
Why independent healthcare for prisoners is vital – Judge Edwin Cameron
Correctional Services committee briefed on lack of psychiatric beds
16 years and R2.1bn later, Kimberley Mental Health Hospital remains barely used
Wrongful incarceration case exposes Eastern Cape mental health crisis