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?