BOOK REVIEW

The Handbook of Forensic Mental Health in Africa

by Ogunwale A, Ogunlesi A, Shepherd SM, Serpa KI and Singh JP, Eds (2021) 1st ed.

London and New York, Routledge, Taylor & Francis Group. ISBN 978-0-367-45607-8

 

The editors all have considerable experience in forensic mental health. Adegboyega Ogunlesi is a retired provost and chief medical director, and Adegboyega Ogunwale, a chief consultant psychiatrist, at the Neuropsychiatric Hospital, Aro, Abeokuta, Nigeria. Stephane M. Shepherd is an associate professor of forensic psychology in Australia, Katrina I. Serpa provides curriculum development and training solutions in general care and forensic settings around the world and Jay P. Singh is a visiting scholar in the Institute of Criminology at the University of Cambridge, United Kingdom. The chapter contributors come from across Africa, Egypt, Ghana, Nigeria and South Africa, and also from Australia and the United Kingdom.

Sadly, it is common knowledge that in many African countries, mental health services are inadequate and are poorly funded. The fact that African countries have not devoted sufficient resources to general mental health services makes it unlikely that they would fund more specialised branches of psychiatry such as forensic mental health services. In addition to the poor funding of mental health services on the continent, there is also the massive problem of lack of trained manpower in mental health services, including trained psychiatrists. Sub-Saharan Africa has a ratio of approximately one psychiatrist to 1.5 million people. Along with the paucity of general psychiatrists, few practising psychiatrists have received training in forensic psychiatry.

Forensic psychiatry is the branch of psychiatry dealing with the assessment and treatment of mentally disordered offenders. Historically, there have always been difficulties deciding how to deal with people who have a mental disorder and who have committed offences. Difficult decisions about whether to send mentally ill offenders to prison or to hospital, and whether or not offenders are mad or just bad. The M’Naughten rules, which are still in use today, have been a standard test for criminal liability in relation to mentally disordered defendants. They were devised as a reaction to the acquittal in 1843 of Daniel M’Naughten on the charge of murdering Edward Drummond after mistakenly identifying him as the United Kingdom Prime Minister Robert Peel.

This is a ground breaking publication, being the first book ever written about forensic mental health in Africa by African authors in collaboration with experts from other parts of the world. It is an essential reference work especially for those working in Africa. The book is in four parts over 321 pages. The first part, consisting of five chapters, explores the history, cross-cultural sensitivity, policy and best practice in service planning and ethics of forensic mental health systems in Africa. The second part consists of six chapters on forensic mental health assessments. There are chapters on assessments in various settings, expert testimonies and reports and mental health legislation in Africa. The third part looks at special forensic populations, children and adolescents, elderly and females. The fourth part of the book is a single chapter discussing the future directions for forensic mental health in Africa.

This book provides a broad overview of forensic mental health services in Africa and begins with a chapter on its history. The authors discuss the colonial mental health practices in the 18th and 19th centuries, and the fact that mental healthcare in the previously colonised countries still reflect the practices in Europe. They mention the low budgeting for healthcare generally and for mental health in particular. They go on to discuss mental health legislations in various African countries, and the fact that the legal frame works were modelled after the laws of the colonial governments. They emphasised the need to update the laws and to develop culturally relevant risk assessment protocols. They lament the fact that forensic health services remain rudimentary with few centres engaging in forensic mental health practices, and the dearth of specialists requiring the training of multidisciplinary persons for the practice of forensic mental health.

There is an interesting chapter on cultural sensitivity in African forensic mental health settings, which discusses the concept of cultural competence, which it defines as the possession of the cultural knowledge and skills of a particular culture aimed at delivering effective interventions to members of that culture. Importantly, it provides frameworks and recommendations for effective cross-cultural working.

The chapter on mental health legislation and forensic practice in Africa makes sobering reading. It states that some African countries still follow laws enacted in the 19th or 20th centuries. Another alarming statistic is that only 44% of countries in Africa have mental health legislations compared with 77% in Europe, and in places where they exist, there is wide variation. This chapter provides useful comparisons of the mental health law provisions for the treatment of mentally ill offenders within different selected African jurisdictions.

The authors reviewed various specialist areas related to forensic psychiatry including the mental health of children and adolescents within the juvenile justice system in Africa, forensic mental healthcare services for the elderly and female forensic patients. These chapters make compelling reading. In the chapter on juvenile justice system, the authors state that there is a huge juvenile mental health crisis in Africa, most especially the disproportionately high prevalence rates of mental illness amongst incarcerated adolescents. Individuals within the adolescent age group are more likely to break the law than during later life because of their predisposition to risk taking. African countries have a youthful population with almost 60% of Africa’s population is under the age of 25 years, making Africa the world’s youngest continent. This means that the topic of juvenile justice is of vital importance as young people are potential future leaders. The authors discuss possible solutions for solving many problems that exist such as setting up diversion programmes to address the specific problems of juveniles and incorporating mental health services into the juvenile justice system with the goal of reducing criminalization amongst young people.

At the other end of the age spectrum, there are vulnerable elderly people who are prisoners in various correctional institutions and who have special mental and physical health needs. The authors state that there are increasing numbers of elderly offenders in the prison justice system, and they postulate possible explanations for this such as social neglect and worsening socio-economic conditions. The elderly inmates are more likely to have health-related problems such as chronic illnesses, which lead to an increase in health-related costs. Female forensic patients are a growing population in African prisons. Historically, correctional services in Africa remain biased towards males in terms of service planning and delivery.

The final chapter on future directions for forensic mental health is essential reading for anyone who is interested in this area. It discusses service development, changes to mental health legislation, clinical training, development of research collaborations and the need for practice guidelines.

As one would perhaps expect from a multi-authored book, there was some variability in the quality of the chapters. Overall, it is a well written book with comprehensive and up to date references. The language is lucid and easy to understand. This publication provides a comprehensive overview of forensic mental health practices in Africa. Psychiatrists and other mental health workers who currently practise in various African countries and who are required to provide care to patients in various forensic settings such as prisons will find it extremely useful. It should be a standard text for all psychiatric trainees taking their fellowship examinations in Africa.

It will also be useful for people who work with mentally disordered offenders. Mental health practitioners from other parts of the world who would like to increase their knowledge of cross-cultural issues in this area will find it invaluable.

If this book is to be of practical use and not just read in academic circles, the fact that it is relatively pricey may mean that it will not be accessible to all those who can derive benefit from the material.

Dr Helen Sasegbon
MBBS, MSc, FWACP
St Andrew’s Hospital, Northampton, United Kingdom