WINDHOEK – One of the challenges faced by the country’s mental health care facilities is how to discharge mentally ill patients who committed crimes while mentally incapacitated.
This is being compounded by the reluctance of their family members to accept them back into society.

The head of the mental health care centre at the Windhoek Central hospital, Dr Hileni Ndjaba revealed in an interview with New Era that the longest forensic patient has been in the mental health facility for more than 30 years.

Ndjaba explained the forensic patients also referred to as state president patients or SPDs - are individuals who committed a crime because of their mental ill defects and, as a result, prosecution cannot be concluded. 
The crimes are of various nature, including murder, rape, house-breaking, theft, trespassing, assault and attempted murder.

“The longest patient has been here for more than 30 years. Before we opened up our own forensic unit in 1996, patients used to be taken for detention to Bloemfontein in South Africa when Namibia was a province of South Africa,” said Ndjaba. 

When Namibia gained independence, few of these patients were transferred back to Namibia when the forensic unit was opened, she explained. 

From 2002 to date, 106 forensic patients have been discharged, added Ndjaba.
These patients can only be released on recommendation from the Office of the President. 
“We write a report through the Prosecutor-General’s office for them to go back to the chambers (judges) and recommend that they are happy with the decision and progress made by the patient and if the judges are happy with that they send the recommendation to the Office of the President.”

“There was no case where the President said he was not happy. The President signs the papers of discharge and after that the family is called in and a handover is held,” Ndjaba explained the process of release. 
According to the Criminal Procedure Act (Act number 51 of 1977), there is a need for a custodian to be identified among the family members of a patient. 

“There are cases where the patient is ready to go but when we approach the family to identify a custodian, they say ‘no we don’t want anything to do with that person’,” explained Ndjaba. 

She continued: “It then becomes the duty of especially our social workers to educate the family to accept their person because the family may still be stuck on the crime that was committed.” 

Further explaining the reasons why it takes many years to discharge these patients in society, Ndjaba said some of them experience relapses just when they were about to be released. Others do not have custodians (family members) who are willing to accept them and look after them when discharged. 

Factors such as shebeens, or in the case where the alleged offender may have raped a minor and where they are accepted to go once discharged are minors are some of the reasons why they are not discharged easily. 
Forensic patients are kept at three institutions in the country, namely the mental health care hospital in Windhoek, and facilities at Oluno and Gobabis, explained Ndjaba. 

“Initially, they are all supposed to be here (Windhoek) but our bed capacity can only accommodate 80 patients. Gobabis has a bed capacity of 87 while Oluno has 89-bed capacity,” explained Ndjaba. 
She explained that the statistics of forensic patients kept at these institutions are not constant.  “They are added on a daily basis as court proceedings happen,” Ndjaba added. 

Explaining how state president patients are identified, Ndjaba said: “When somebody commits a crime, the magistrate or court where they attend either observes from the way they are responding to questions during the court proceeding that something is not right.” 

Also, a family member can alert the authorities that the alleged offender is known to have a mental condition and that they were on treatment at the time that they committed the crime, elaborated Ndjaba. 
Such people are referred to the mental health care hospital where they are observed for 30 days, explained the psychiatrist. 

“We stop the medication for those who are on medication to see whether they will develop the symptoms and for those who are not on medication we keep them without medication because we know that if they have suffered or are suffering from a mental illness they will definitely display the symptoms while they are with us,” said Ndjaba. 
Not all the alleged offenders who are sent by the court for evaluation are mentally ill, added Ndjaba. 

“Some of them can pretend to be mentally ill because there was a perception that if you are mentally ill you are just let to go home and you are not given a prison sentence,” Ndjaba explained. 
Those who are evaluated and found to be mentally ill at the time of the alleged crime was committed are declared state president patients, the psychiatrist explained.

“So they are not criminally responsible for their actions because of their mental defect and the court then declares them state patients,” she further explained. 

These patients are sent for treatment and rehabilitation until such a time that the doctors, psychiatrists or social workers treating them observe that they are at an “optimum level”, Ndjaba explained. 
This means that they now function properly when sending them back into society. 
“Their detention as state president patient is not based on the case (crime) that they have committed. It’s more depending on their functionality,” added Ndjaba.