Prison for therapy? Here’s why mentally ill patients are behind bars instead of in hospitals
· Citizen
Skeptical MPs on Tuesday had many questions after the Correctional Services Portfolio Committee revealed that 437 individuals, deemed mentally unfit for criminal responsibility, are being held in prisons rather than psychiatric hospitals.
The number has doubled in two years, from 204 and 117 in 2020.
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The health department said it partly has to do with the grim fact that state patients can be housed in only one of the 14 facilities available to them across South Africa. And this is only if beds are available at the time of their order.
The other reason is that if beds aren’t available, correctional services temporarily keep the psychiatric patients in their facilities.
“How is keeping them in prison the middle ground that we’ve settled on?” asked the DA’s Kabelo Kgobisa-Ngcaba.
“The reason why they weren’t convicted is that they’re not well. So they don’t, even the violent ones, belong in prison.
“It’s incredibly inhumane, indecent and inconsistent with our constitution.”
Prison waiting list
Ideally, authorities should transfer a state patient to a psychiatric hospital within 30 days, but this rarely happens.
Inspecting judge Leonard Bozalek, for the Judicial Inspectorate for Correctional Services, said a state patient from the Pietermaritzburg Medium A facility has been detained since 2020.
The EFF’s Carl Niehaus sought clarity on the backlog of processing accused who need forensic observation.
“It’s true that accused wait for a very long period of time for their assessments,” said Nicholas Crisp, the health department’s acting director-general of the NHI.
2783 patients are still waiting for observations, while only 339 have been newly admitted to psychiatric hospitals.
Dudu Shiba, director of the mental health and substance abuse at the department of health (DoH), said the referral load continually increases, with “about 10% of these declared state patients”.
The health department said it doesn’t have the budget to clear backlogs.
“The DoJ&CD has not been paying DoH for forensic mental observations conducted since 2023. The amount of R380 million is currently outstanding. The DoH continues to use its resources for this service that is not funded,” it said.
Clear backlogs by changing the law
Bozalek proposed that the law be changed so that courts aren’t able to refer state patients to correctional services.
“Alternatively, which I prefer, is that if there’s no bed in a mental health institution, refer that patient to a correctional facility for a maximum of 30 days,” he said.
He said if no changes occurred by then, the head of the facility should go to court for a different order to refer the person back to a health facility.
Misrepresentation of ‘state patient’
Shiba said on top of this, courts are increasing the number of state patients by declaring mentally unfit people, who committed a petty crime, as state patients.
Even though, by law, they are supposed to be admitted as involuntary mental health care patients, who should receive care from any of the 64 hospitals designated in the Mental Health Care Act, only 6 290 have been admitted.
Only serious crime offenders should be treated as state patients, yet overcrowded prisons become even more crammed with unnecessary court orders.
More than 168 000 inmates are currently squashed into facilities built for just more than 107 000, with South Africa’s correctional system operating at 58% over capacity.
“If you were to increase the current hospital population with all the guys who are in prison, it’s just a 10% increase,” Ncaba said.
Anna Molepo, chief deputy commissioner responsible for rehabilitation, said that only 159 state patients have been removed from prisons to health facilities.
“What message do you think it sends when we continue to use prisons as de facto psychiatric wards?” asked the DA’s Janho Engelbrecht.
Not enough hospitals, psychiatrists and beds
There are 942 psychiatrists in South Africa. Of these, 707 work in the private sector, while the majority of patients are being attended to in the public sector.
“The private sector makes it hard to employ people,” said Crisp.
Rural facilities like Komani, Umzimkhulu and Hayani see insufficient healthcare because fewer psychiatrists are willing to work there and community health centres aren’t generally prioritised.
However, “a psychiatrist was appointed in 2025 for Komani Psychiatric Hospital through headhunting,” the health department said.
Where is the Mpumalanga facility?
There are only 14 health facilities in the country with the capacity to admit state patients. At least two exist in each province. Except for Mpumalanga.
It doesn’t have a single psychiatric facility for state patients, which poses an administrative challenge. This includes transferring patients across provincial borders, families becoming estranged, and bringing more patients into understaffed facilities.
The committee was told that construction plans for Mpumalanga started in 2022.
“It is now four years later and you said exactly the same thing,” said Engelbrecht. “What exactly is the current state of that project?”
Crisp said the building has only been designed, but no physical location has been selected.
“It’s been designed for some time and it is in the BFI,” he said.
He added that the nature of the BFI, a treasury-managed infrastructure fund for new buildings in South Africa, is hindering construction.
“There’s an expectation from Treasury that our facilities must generate revenue. Now I ask you, how does a mental health facility in the public sector generate revenue? It’s not possible.”
“We were even asked ‘can’t we charge more for the parking?’. I mean that’s like a slap in the face to the health department,” he said.
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