THE MENTAL health of offenders was a previously shelved topic, but has recently become quite topical in our society. It is apparent that the general knowledge of mental disorders and the contribution of these disorders to offending behaviour are limited. The majority of mentally ill persons do not engage in violent or criminal acts, but when they do a number of issues will arise.

One issue is whether the offender was mentally ill at the time of committing the offence. This determination is based on specific features of the defendant's mental status at the time of the offence. The alleged offender's mental status at any other time has no bearing on this determination of legal insanity. To be found legally insane is equivalent to not being criminally responsible for the particular act. It has to be determined whether the defendant chose to do the wrong thing of his/her own free will.

The McNaghten Rule

This is outlined by the Mc-Naghten Rule, which stated that: "It must be clearly proved that, at the time of the committing of the act, the party accused was labouring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act he was doing; or if he did know it, that he did not know that what he was doing was wrong." This rule stemmed from a murder committed by Daniel McNaghten, in England in 1843, as a result of his paranoid delusions. He knew he was killing, but did not appreciate the nature of his act, as he regarded his act as one of self-defence against a threat to his life. His belief was false, but was a symptom of his paranoid and delusional condition which prevented him from evaluating alternative options, such as reporting the perceived threat or taking evasive action.

An opinion on the defendant's mental state is usually provided by a psychiatrist, with the ultimate decision being made by the judge/ jury empanelled to make such a decision. However, the mere presence of a severe mental illness at the time of the offence does not imply legal insanity, as the mental illness may not affect all areas of the defendant's mental functioning.

Another important consideration is whether the defendant is fit to plead at the time of the trial. A person can be unfit to plead, but have been legally sane at the time of the offence or have been legally insane at the time of the offence and then fit to plead. Again, the job of the psychiatrist is to provide evidence of the defendant's state going into the trial with the final determination on fitness to plead being made by the judge. Being mentally ill does not automatically render an individual unfit to plead. If the defendant is unfit to plead, but treatable, the trial should be adjourned until the defendant is fit.

Public education needed

There is an urgent need for appropriate services to be de-veloped to treat and rehabilitate mentally ill offenders. In addition, there is the need for an appropriate legal framework to be instituted to facilitate the treatment of these individuals instead of the more punitive approach which currently exists. Education of all members of our society is also necessary to ensure all stakeholders have an awareness and understanding of the issues related to mental illness. This will go a far way in reducing the misconceptions and stigma associated with chronic mental illnesses.

I am, etc.,

Dr CLAYTON A. SEWELL

Consultant psychiatrist- Forensic Specialist

University Hospital ofthe West Indies

Education of all members of our society is also necessary to ensure all stakeholders have an awareness and understanding of the issues related to mental illness. This will go a far way in reducing the misconceptions and stigma associated with chronic mental illnesses.