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Forensic Mental Health Services at Zomba Prison & ZMH

Forensic Mental Health Services at Zomba Prison & ZMH. Harry Kawiya & Owen Mwale. Background. Malawi prisons face inadequate mental health services Undertreated or mistreated 1 medical doctor, 1 clinical officer, and no nurse No mental health expert

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Forensic Mental Health Services at Zomba Prison & ZMH

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  1. Forensic Mental Health Services at Zomba Prison & ZMH Harry Kawiya & Owen Mwale

  2. Background • Malawi prisons face inadequate mental health services • Undertreated or mistreated • 1 medical doctor, 1 clinical officer, and no nurse • No mental health expert • Severely mentally ill are assessed by Clinicians from ZMH

  3. Objective • To improve mental health services at Zomba Prison

  4. Results • First clinic was in July, 2012 • 36 clients were assessed • 35(M), 1(F) • Age range 20-56 • 23 (63.9%) were known clients with mental illness and 13 (36.1%) were unknown • 28 (77.8%) were already convicted while 8 (22.2%) were on remand.

  5. Cont… • schizophrenia 17 (42.7%) and substance induced psychosis 11 (30.6%). • Murder 14 (38.9%), rape 8 (22.2%) and theft 7 (19.4%) • 9 (52.9%) clients who were diagnosed as schizophrenia committed murder • 5 (45.4%) clients who were diagnosed as substance induced psychosis committed rape

  6. Diagnosis

  7. Immediate Outcome • Some clients were pardoned • Reduction of referrals to ZMH from prison • Improvement in case management

  8. Challenges • High workload (20-30 clients each clinic) • Frequent transfers of clients

  9. ZMH • Acutely unwell forensic clients • Assessment & management • Report writing • Appearing before court • Assessments of 5 booked forensic clients from police stations • Monthly forensic clinic at Zomba Prison

  10. Achievements • All booked forensic clients are assessed same day • Reports are written same day • Intervention for acutely unwell • Some booked forensic clients are diverted for management

  11. Challenges • Shortage of human resource • No Forensic Mental Health Experts • Inadequate documents from police • Collateral information is a problem • Police take time to pick clients from the hospital • Lack of medium secure psychiatric environment

  12. THE END ANY QUESTION?

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