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
• Severely mentally ill are assessed by Clinicians
from ZMH
Objective
• To improve mental health services at Zomba
Prison
Results
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•
•
•
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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.
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
Diagnosis
Diagnosis
18
16
14
12
10
Diagnosis
8
6
4
2
0
Acute Trans
BAD
Dementia
Epilepsy
Epi Psy
HIV Psy
Mania
SCZ
Sub Induced
Immediate Outcome
• Some clients were pardoned
• Reduction of referrals to ZMH from prison
• Improvement in case management
Challenges
• High workload (20-30 clients each clinic)
• Frequent transfers of clients
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
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
Challenges
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•
•
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•
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
THE END
ANY QUESTION?