Inequities in Forensic Mental Health in South Africa and Recommendations for Service Development

The roots of South Africa’s forensic mental health system are plagued by its colonial and apartheid legacy. Extensive forensic waitlists exist partly due to restrictive criminal justice legislation and an under-funded forensic mental health system, predicated largely on European norms and standards. There are several areas of concern in South Africa’s forensic mental health system, which may be viewed as inequitable to Black Africans and other marginalized groups. Black Africans are over-represented in the forensic mental health system, and many defendants are not fluent in English – the official language of the courts. The absence of competency restoration can result in extended detention in forensic hospitals. People with intellectual disabilities are disproportionately targeted for sexual assault, and face significant barriers in attempts to achieve justice. Further, the colonial legacy of the rebuttable presumption of doli incapax (children presumed incapable of forming criminal intent) can affect determinations of children’s criminal capacity. These issues warrant change, including introducing competency restoration, improving systems for testimony by sexual violence survivors with intellectual disabilities, reconsidering the rebuttable presumption in child justice matters, and using psychologists and outpatient evaluations to address the waitlists for forensic examinations. Comparisons are also made with US standards, challenges, and developments, especially in view of the authors’ knowledge of both systems and the common challenges facing them.