The profile of mentally ill offenders in Katsina, Northern-Nigeria.

African Journal of Psychiatry • August 2009 231 The shift towards community care for patients with chronic mental illness has resulted in an increase in the number of forensic patients.1 This has been associated with other factors such as gender, education, poverty, diagnosis, psychopathology and lack of access to mental health services.2-4 In Sub-Saharan Africa and other Low and Middle Income Countries(LAMIC) access to mental health facilities is poor and often difficult.5 A study in Nigeria estimated that 70% of the population had no access to mental health facilities.6 Moreover, in Nigeria, all the mental health centres are located in urban areas and require out-of pocket payment for access to their services.6 The situation is further complicated by the tortuous pathway to mental health services in Nigeria leading to delay in presentation, increased morbidity and poor outcome.7 Schizophrenia, substance use disorders and organic mental disorders are the commonly reported diagnoses among mentally ill offenders.4,8,9 These disorders can be managed adequately by providing accessible and affordable mental health services in the community. Such services might likely reduce offending behaviours among mentally ill patients. This retrospective study was conducted at the Katsina State Psychiatric Hospital in Katsina, Northern Nigeria. Materials reviewed were the clinical records and forensic assessment reports of all the patients referred to the hospital by the criminal justice system over a 2 year period. Information retrieved for analysis included sociodemographic characteristics, diagnoses, offending behaviour and other related indices. A total of 19 patients were referred to the hospital for forensic assessment during the period under review. The mean age of the patients was 28.94 ±9.34 years. The mean age of the female patients was 32.40±14.82 years, while that of male patients was 27.71±6.85 years. There was no significant difference between the mean ages of the male and female patients (t= .68, p=.53). The mean duration of illness among these patients was 8.05±7.78 years. All the patients were either single or divorced as at the time of presentation. None of the patients was gainfully employed at the time of presentation. Other socio-demographic characteristic of the patients are shown in Table I. Homicide was the most common offending behavior committed by these patients, accounting for 68% of all the offences. There was no significant difference in the mean ages and duration of illness between patients that committed homicide and other offending behaviours respectively (t=.016, p= .98; t=.48, p= .71). The act of homicide was significantly associated with living in a rural area (c2=7.36, p=.007), not having formal education (c2=4.99, p=.046) and having a diagnosis of schizophrenia (c2=10.87, p=.003). Relatives of the patients were the most likely victims of offending behavior (c2=12.06, p=.001). Gender, substance use and previous contact with mental health services were not significantly associated with homicide. The socio-demographic characteristics of the patients are similar to those reported by other studies of mentally abnormal offenders.2-4 The majority of the patients are young, unemployed males, single without formal education. Similar observations were made by Ogunlesi et al in Southern Nigeria and Pal in Papau-NewGuinea.8,2 The profile of mentally ill offenders in Katsina, NorthernNigeria