Factors associated with the readmission of State patients on extended leaves of absence from Sterkfontein Hospital

Abstract

Introduction A State patient is a person with a mental illness or intellectual disability, who has been found unfit to stand trial and/or not criminally responsible, for a crime involving serious violence, under Sections 77 and 78 of the Criminal Procedure Act No.51 of 1977 and has subsequently been declared a State patient by the presiding officer in terms of Section 42 of the MHCA. Such patients are detained in forensic hospitals to undergo appropriate rehabilitation. If they are assessed as low risk to relapse and reoffend, State patients are granted leaves of absence (LOA) from the hospital in an attempt to reintegrate them into their communities, with the goal of conditional and eventual unconditional discharge. Limited research on the readmission of forensic patients exists currently in low- and middle-income countries. Hence, there is the need to conduct local studies to identify factors associated with readmission, with the aim of mitigating these factors and decrease the demand on forensic psychiatric services. Aim To compare the profile of State patients readmitted from extended LOA from Sterkfontein Hospital, to those who were not readmitted. Methods The study was a retrospective record review conducted from 2018 to 2020 at the Sterkfontein hospital forensic psychiatric unit. The study compared the socio-demographic, clinical, forensic and psychosocial factors associated with readmission between readmitted and non-readmitted groups. Results A total of 112 participants (56 readmitted and 56 non-readmitted patients) were included in the study. The following results were obtained from the readmitted group; 46.4% used cannabis on leave of absence; 35% lacked supervision; 64.3% showed poor treatment adherence; and 10.7% reported poor availability of medications at the local clinic. viii Conclusion and recommendations Poor adherence, lack of supervision and substance use were associated with readmission from extended LOA. The implementation of programmes such as Assertive Community Treatment, and the strengthening of existing substance rehabilitation services are recommended to support State patients and their families in order to improve treatment adherence, maintain abstinence from substances and prevent readmission.