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Tue May 24 15:47:43 CAT 2016

Crime suspects' mental health assessments could soon go hi-tech

S'Duduzo Dludla and Roxanne Henderson | 22 February, 2016 06:15
Pistorius's assessment started within days of the court order being made. He was treated as an out-patient at Pretoria's Weskoppies psychiatric hospital. File photo
Image by: SIPHIWE SIBEKO / REUTERS

Mental health assessments of crime suspects could soon go hi-tech as the inability of state psychiatric institutions to meet the demand for their services forces doctors to consider resorting to technology such as video-conferencing.

This is just one of the plans the Health Department is considering to reduce the long waits for court-ordered psychiatric evaluations of people accused of a crime. The delay can be up to a year.

The plan could meet resistance, with one psychologist labelling it "ridiculous".

Johannesburg businessman Yengesen Pillay, who will soon go on trial for his wife's murder, was behind bars for over a year while awaiting psychiatric evaluation.

Daluxolo Sihlali, convicted in September of murdering his mother, is still waiting for hospital accommodation and his assessment.

The Justice and Correctional Service Department said at the end of December that 252 court cases had been postponed while the accused awaited psychiatric evaluation.

Lawyer Ian Levitt said legal representatives often encouraged their clients not to apply for observation because of the long delays they created in the hearing of cases.

In December, postponing the murder trial of Carlos Higuera because he had not yet been psychiatrically assessed, Johannesburg magistrate Albertus Roux criticised the authorities for not doing more to alleviate the backlog.

Higuera is accused of murdering Chumani Nqakula, the son of Defence Minister Nosiviwe Mapisa-Nqakula. He was referred for mental evaluation in November.

Roux questioned why disabled Paralympian Oscar Pistorius did not have to wait to be assessed.

Pistorius's assessment started within days of the court order being made. He was treated as an out-patient at Pretoria's Weskoppies psychiatric hospital.

At the time, lawyers cried foul, saying they had not before heard of an out-patient assessment.

But Justice Department spokes-man Mthunzi Mhaga said the out-patient system was available for all accused persons who were out on bail.

Health Department spokesman Joe Maila said the courts decided whether an accused should be admitted for assessment or treated as an out-patient.

A shortage of beds at state psychiatric hospitals is the main reason for the psychiatric assessment backlog, which is most severe in Gauteng.

Maila said out-patient evaluations would be only part of the solution.

The backlog will persist as long as hospitals remained understaffed, he said, and that was why the department was revitalising hospitals and trying to attract more clinicians.

It was also exploring the use of new technology such as "tele-medicine" to provide healthcare to patients from a distance.

Maila said tele-medicine, and forensic tele-psychiatry in particular, had been shown to improve access to specialist skills, save on transportation costs and reduce hospitalisation time.

Tele-psychiatry would enable psychiatrists to assess patients and provide care through technologies such as video-conferencing.

Clinical psychologist Ivan de Klerk, however, rejected this plan.

"[It is] ridiculous. You would miss subtle messages from the patient. The Health Professions Council of SA said the use of such methods would be 'ill-advised'," he said.

De Klerk also dismissed out-patient psychiatric evaluations.

"It is not a viable option because a person could come in for two hours and fake it. You need to observe a patient over 24 hours."

He said the solution was for the department to allocate more money to psychiatric services, build bigger wards and attract staff.

Clinical psychologist Saths Cooper said tele-medicine could provide quality healthcare to poor rural communities and was being used all over the world.

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