THE PREVALENCE OF MENTAL DISORDERS AMONG OFFENDERS ADMITTED AT HEALTH FACILIITIES IN BIZZAH MAKHATE CORRECTIONAL SERVICE CENTRE, KROONSTAD, SOUTH AFRICA MOSA BONOLO MODUPI Department of Psychiatry Faculty of Health Sciences University of the Free State Bloemfontein, South Africa This study/article is submitted in accordance with the requirements for the Degree of MASTER OF MEDICINE (MMED) IN PSYCHIATRY November, 2019 Supervisor: Prof. N.L. Mosotho Declaration I declare that the study/article hereby submitted by me for the Master of Medicine (MMEd) Degree in Psychiatry, at the University of the Free State, is my own independent work and has not previously been submitted at another university/faculty. I, furthermore, cede copyright of this study in favour of the University of the Free State. Mosa Bonolo Modupi November, 2019 i Acknowledgements I would like to express my appreciation to the following people who helped make this study achievable. • Prof N.L. Mosotho Supervisor, for technical and scientific guidance. • Ms. H.E. le Roux for careful and accurate way of editing the documents. • To the colleagues at the Department of Psychiatry University of the Free State. • To the personnel of Bizzah Makhate Correctional Centre for their assistance in accessing the study participants. ii Dedication I would like to dedicate this study to my son, Atlehang Modupi and my husband Seisa Modupi for their support and encouragement. iii Table of Contents Declaration i Acknowledgements ii Dedication iii Abstract v List of Tables vi List of Abbreviations vii Appendices viii Chapter 1: Literature Review 1 Introduction 1 Objectives 5 Research Questions 6 References 7 Chapter 2: Publishable Manuscript 12 Abstract 12 Background 13 Ethical Considerations 15 Aim of the Study 15 Methodology 16 Instrument 17 Data Analysis 17 Results 18 Discussion 22 Conclusion 24 References 26 iv Abstract Mental disorders are reportedly more prevalent in prisons than expected. The aim of this study was to determine the prevalence of mental disorders among offenders admitted at the health establishments in Bizzah Makhathe Correctional Centre, Kroonstad, South Africa. Structured psychiatric interviews were conducted to elicit the information. The majority of the participants were young males, black Africans with low educational levels, coming from low socio-economic backgrounds. Crimes against human beings were jointly the most common ones committed by the offenders. The lifetime prevalence of mental disorders was 54.7%. Personality disorders, followed by substance and addictive disorders were the most prominent disorders among the study sample. Other psychiatric disorders noted were depressive disorders, schizophrenia spectrum, intellectual disabilities and neurocognitive disorders, etc. It is agreed that a notable number of prisoners suffering from mental disorders goes undetected, undiagnosed and untreated. Constructs of competency to stand trial and criminal responsibility should always be observed. There is a need to conduct more empirical studies on the prevalence and incidences of mental disorders in correctional service centres in South Africa. Key words: prevalence, mental, disorders, correctional service centres, offenders, health facilities, diagnosis, crimes, demographics, psychiatric interview v List of Tables Table 1 Sociodemographic Characteristics 18 Table 2 Crimes 20 Table 3 Psychiatric Diagnosis 21 vi List of Abbreviations APA American Psychiatric Association DSM-5 Diagnostic and Statistical Manual of Mental Disorders, 5th edition HSREC Health Sciences Research Ethics Committee ICD-10 International Classification of Diseases MSE Mental Status Examination UFS University of the Free State WHO World Health Organisation vii Appendices A. Letter of approval from Health Sciences Research Ethics Committee B. Research application documents from Correctional Services C. Approval letter from Department of Correctional Services D. Permission letter from Head of Department E. Copy of Research Protocol approved by Health Sciences Research Ethics Committee F. Informed Consent G. Questionnaire/Psychiatric interview H. Summary of Turnitin Plagiarism Search Engine I. Submission Guidelines: Psychiatry, Psychology and Law viii CHAPTER 1 LITERATURE REVIEW Introduction International epidemiological studies have found that mental disorders are more common in correctional service centres than expected, with major psychiatric disorders 10 times more prevalent than in the general population (Andreoli et al., 2014). These findings are also supported by Watzke, Ullrich and Marneros (2006), who highlight that mental illness is prevalent in prisons; the admission rate to correctional service establishments has increased in many countries over the past few years. Zabala-Baños et al. (2016) explain that due to this phenomenon of high prevalence of mental disorders in prisons, the composition and typology of prison populations and criminal and behavioural patterns have been affected. Although the findings of the epidemiological studies on mental health disturbances among prisoners may vary from country to country, the high prevalence of mental illness among prisoners remains the common factor. Data on the prevalence of mental illness in correctional service establishments are of utmost importance for the management of mental diseases and for the cost, planning and policy formulation by the departments of correctional services and health (Brown, Hirdes, & Fries, 2015). The literature indicates that mental disorders are more prevalent in correctional service institutions than in the general population. There is a rapid growth in the admission rate of prisoners in correctional service facilities across different countries, estimated to be between 9 and 10 million prisoners at a time worldwide (Sepehrmanesh, Ahmadvand, Akasheh, & Saei, 2014). Based on recent published statistics, the prevalence of mental disorders in detained offenders has become a common debated subject. Lafortune (2010) reports that although there has been a significant increase in prison population in the last two 1 decades, a large number of admitted prisoners with mental illness are undiagnosed and untreated. Identification and treatment of mental disorders in detained offenders can be difficult if the disorder was missed by correctional services during admission (Graf et al., 2013). The high prevalence of mental disorders in correctional services may be attributed to inadequate mental health services in the communities, absence of detection and identification mechanisms for the signs and symptoms of mental illness during court proceedings, and incarceration itself which may be a risk factor for the development of mental disorders (Audi, Santiago, Garcia Andrade & Francisco; 2018; Bebbington et al., 2017). Correctional service centres are described as an associated factor for the development of mental health disturbances; some individuals might have already been suffering from mental disorders before imprisonment or occasionally mentally healthy people develop emotional and psychological problems due to exposure to prison and the conditions of the prison environment. Social exclusion and inadequate health care provisions in correctional service facilities also largely contribute to the development of mental disorders in convicted offenders (López, Saavedra, López, & Laviana, 2016). It is reported that mental illness is prevalent and is recognised as a public health matter worldwide (dos Santos, dos Santos Barros, & Andreoli, 2019). Therefore, the need for mental health services and scientific investigations in correctional service centres has grown in recent decades. The assessment and screening of symptomatology of mental disorders at the entry points to services should be an integral part of mental health services in these institutions (Martin, Hynes, Hatcher, & Colman, 2016). Standardised routine screening of mental illness on admission can significantly reduce the number of untreated prison inmates and ensure early psychiatric interventions (Parsons, Walker, & Grubin, 2001). Regarding the background 2 information provided above, it can be said that mental illness in correctional service facilities is one of the budget burdens for governments (Al-Rousan, Rubenstein, Sieleni, Deol, & Wallace, 2017). The provision of mental health services in general, requires adequate and expensive physical and human resources. Undetected and untreated mental illnesses may result in fatal outcomes; therefore, regular administration of screening tools in correctional facilities is of the utmost importance. These psychological and psychiatric disturbances are some of the main sources of morbidity among prisoners (Chow et al., 2018). Solomon, Mihretie and Tesfaw (2019) explain that common mental disorders are the second most common type of illness in developing countries. Common mental disorders refer to a cluster of psychiatric conditions that includes anxiety, depression and somatoform disorders. It has been widely documented that mental disorders are overrepresented in prisons. It is well known that psychiatric disorders usually expose individuals to the risk of developing suicidal tendencies and the risk of death during and after incarceration (Nacher et al., 2018). The incidences of suicide among prisoners are reportedly higher in comparison with the general population (Osasona & Koleoso, 2015). Kang, Wood, Louden and Ricks (2018) conducted a study on the prevalence of internalising, externalising and psychotic disorders among low-risk juvenile offenders in the southwestern United States. The results revealed that young offenders presented with various mental disorders such as substance abuse disorders, disruptive disorders, mood disorders, anxiety disorders and psychotic disorders with varying prevalent rates, ranging between 2% and approximately 28%. In France, Combalbert et al. (2016) reported that the prevalence of mental disorders was markedly higher among old prisoners, estimated to range up to 70%. They found mood and anxiety disorders to be more prevalent among the old offenders, to the prevalence rate of more than 50%. A similar study on the prevalence of mental disorders 3 among male prisoners was conducted in Ecuador by Benavides et al. (2019) which found that one in five study subjects was diagnosed with both depression and a psychotic disorder at the same time. In general, there was a high prevalence of depression and psychosis in their study population. Furthermore, Ayhan et al. (2017) found the suicidal risk among prisoners in French Guiana to be just above 13%, while depression affected over 14%. These scientific reports collaborate what has been reported on the link between mental disorders and self- harming behaviours (Gates, Turney, Ferguson, Walker, & Staples-Horne, 2017). In Australia, Heffernan, Andersen, Davidson and Kinner, (2015) reported a high prevalence of post- traumatic stress disorder among Aboriginal and Torres Strait Islander individuals in correctional centres. Similarly, high trauma exposure was reported among inmates in the southeast of Spain in the study by Sánchez, Zargoza, Fearn and Vaughn (2017). At the Horn of Africa, specifically Addis Ababa, Ethiopia, Solomon et al. (2019) found the prevalence of common mental disorders to be approximately 60%. A study on the prevalence of personality disorders was conducted among male prisoners in Portugal (Brazão, da Motta, Rijo, & Pinto-Gouveia, 2015) which revealed that 80% of male offenders met the full criteria for personality disorders, while more than half of those inmates were diagnosed with antisocial personality disorders. On the other side of Europe, research was conducted in Stockholm by Wetterborg, Långström, Andersson and Enebrink (2015) which found that almost 41% of the offenders on probation presented with a borderline personality disorder. There was also comorbidity of other disorders such as antisocial personality disorder, major depressive disorder, substance use/abuse disorder, attention deficit hyperactivity disorder (ADHD) and anxiety disorders among that study population. In Iran, it was found that ADHD affected 16.2% of the male prisoners (Hamzeloo, Mashhadi, & Fedardi, 2016). The results showed comorbidity of other psychiatric disorders like major depressive disorders, anxiety disorders, posttraumatic stress disorder (PTSD), personality 4 disorders and substance use disorders in offenders diagnosed with ADHD. Moreover, another study was conducted in Australia among New South Wales (NSW) prisoners to assess the prevalence of ADHD and psychiatric comorbidities which revealed that 17% of the study subjects were diagnosed with ADHD and there was no gender difference, while Aboriginal Australian inmates were diagnosed with adult ADHD more often than non-Aboriginal offenders (Moore, Sunjic, Kaye, Archer, & Indig, 2016). The findings of the said study were somehow different from what was reported in the Iranian study. The global prevalence of mental health issues is likely to affect South Africa as well. It is important to note that there is dearth of data regarding the prevalence of mental disorders in South African correctional and rehabilitation facilities. Naidoo and Mkize (2012) write that South African correctional services centres are the most populated in Africa. In March 2015, South Africa had a total prison population of 159,241 according to the World Prison Brief; it has the 11th largest prisoner population globally. It is against this background that the principal researcher decided to conduct a study on the prevalence of mental disorders in a South African prison, Bizzah Makhate, in Kroonstad. The South African government policy is that the researchers should focus on their local communities to meet the needs of the communities. The principal researcher herself is part of the Kroonstad community. The documentation and description of the incidences and prevalence of mental disorders in correctional service centres will assist the government of South African to meet the basic needs of the mental health services for inmates. Objectives 1. The objective of this study was to explore the literature on the prevalence of mental disorders in correctional facilities and to assess the socio-demographic characteristics associated with those disorders. 5 2. Therefore, the main aim of the study was to assess the prevalence of mental disorders and associated factors among offenders admitted to the health facilities at Bizzah Makhate Correctional Centre, Kroonstad, South Africa. Research Questions 1. What is the prevalence of mental disorders among offenders admitted to the health facilities in Bizzah Makhate Correctional Centre? 2. What are the socio-demographic characteristics of those offenders admitted in those facilities? 3. What are the crimes committed by those offenders? 4. Is there any association between the diagnoses and crimes? 6 References Al-Rousan, T., Rubenstein, L., Sieleni, B., Deol, H., & Wallace, R. B. (2017). Inside the nation’s largest mental health institution: A prevalence study in a state prison system. BioMed Central Public Health, 17(342), 1−9. doi:10.1186/s12889-017-4257-0 Andreoli, S. B., dos Santos, M. M., Quitana, M. I., Ribeiro, W. S., Blay, S. L., Taborda, J. G. V., & de Jesus Mari, J. (2014). Prevalence of mental disorders among prisoners in the State of Sao Paulo, Brazil. Public Library of Science, 9(2), 1−7. doi: 10.1371/journal.pone.0088836 Audi, C. A. F., Santiago, S. M., Garcia Andrade, M., & Bergamo Francisco, P. M. S. (2018). Transtorno mental comun entre mulhere encarceradas: estduio de prevaléncias e fatores associados [Common mental disorders among incarcerated women: A study on prevalence and associated factors]. Ciencia & Saudde Coletiva, 23(11), 3587– 3596. doi:10.1590/1413-812320182311.30372016 Ayhan, G., Arnal, R., Basurko, C., About, V., Pastre, A., Pinganaud, E., Sins, D., Jehel, L., Falissard, B., & Nacher, M. (2017). Suicide risk among prisoners in French Guiana: Prevalence and predictive factors. BMC Psychiatry, 17(156), 1–10. doi:10.1186/s12888-017-1320-4 Bebbington, P., Jakobowitz, S., McKenzie, N., Killapsy, H., Iveson, R., Duffield, G., & Kerr, M. (2017). Assessing needs for psychiatric treatment in prisoners: 1. Prevalence of disorder. Social Psychiatry & Psychiatric Epidemiology, 52, 221–229. doi:10.1007/s00127-016-1311-7 Benavides, A., Chuchuca, J., Klaic, D., Waters, W., Martin, M., & Romero-Sandoval, N. (2019). Depression and psychosis related to the absence of visitors and consumption of drugs in male prisoners in Ecuador: A cross sectional study. BMC Psychiatry, 19, 248. doi:10.1186/s12888-019-2227-z 7 Brazão, N., da Motta, C., Rijo, D., & Pinto-Gouveia, J. (2015). The prevalence of personality disorders in Portuguese male prison inmates: Implications for penitentiary treatment. Análise Pscicologica, 3(XXXIII), 279–290. doi:10.14417/ap.975 Brown, G. P., Hirdes, J. P., & Fries, B. E. (2015). Measuring the prevalence of current, severe symptoms of mental health problems in a Canadian correctional population: Implications for delivery of mental health services for inmates. International Journal of Offender Therapy and Comparative Criminology, 59(1), 27−50. doi:10.1177/0306624X13507040 Chow, K. K. W., Chan, O., Yu, M. W. M., Lo, C. S. L., Tang, D. Y. Y., Chow, D. L. Y., Siu, B. W. M., & Cheung, E. F. C. (2018). Prevalence and screening of mental illness among remand prisoners in Hong Kong. East Asian Archives of Psychiatry, 28, 134– 138. doi:10.12809/eaap1829 Combalbert, N., Pennequin, V., Ferrand, C., Vandervyvére, R., Armand, M., & Geffray, B. (2016). Mental disorders and cognitive impairment in ageing offenders. The Journal of Forensic Psychiatry & Psychology, 27(6), 853–866. doi:10.1080/14789949.2016.1244277 dos Santos, M. M., dos Santos Barros, C. R., & Andreoli, S. B. (2019). Fatores associados á depressão em homense mulheres presos [Correlated factors of depression among male and female inmates]. Revista Brasileira de Epidemiologia, 22, 1–14. doi: 10.1590/1980-549720190051 Gates, M. L., Turney, A., Ferguson, E., Walker, V., & Staples-Horne, M. (2017). Associations among substance use, mental health disorders, and self-harm in prison population: Examining group risk for suicide attempt. International Journal of Environmental Research and Public Health, 14, 317. doi:10.3390/ijerph14030317 8 Graf, M., Wermuth, P., Häfeli, D., Weisert, A., Reagu, S., Pflüger, M., Taylor, P., Dittmann, V., & Roland, J. (2013). Prevalence of mental disorders among detained asylum seekers in deportation arrest in Switzerland and validation of the Brief Jail Mental Health Screen BJMHS. International Journal of Law and Psychiatry, 36, 201−206. doi.10.1016/j.ijlp.2013.04.009 Hamzeloo, M., Mashhadi, M., & Fedardi, J. S. (2016). The prevalence of ADHD and comorbid disorders in Iranian adult male prison inmates. Journal of Attention Disorders, 20(7), 590–598. doi:10.1177/1087054712457991 Heffernan, E., Andersen, K., Davidson, F., & Kinner, S. A. (2015). PTSD among aboriginal and Torres Strait Islander people in custody in Australia: Prevalence and correlates. Journal of Traumatic Stress, 28, 523–530. doi:10.1002/jts.22051 Kang, T., Wood, J. M., Louden, J. E., & Ricks, E. P. (2017). Prevalence of internalizing, externalizing, and psychotic disorders among low-risk juvenile offenders. American Psychological Association, 15(1), 78–86. doi.org/10.1037/ser0000152 Lafortune, D. (2010). Prevalence and screening of mental disorders in short-term correctional facilities. International Journal of Law and Psychiatry, 33(2), 94−100. doi: 10.1016/j.ijlp.2009.12.004 López, M., Saavedra, F. J., López, A., & Laviana, M. (2016). Prevalence of mental health problems in sentenced men in prison from Andalucìa (Spain). Revista Española de Sanidad Penitenciaria, 18, 76−84. Retrieved from http://scielo.isciii.es/pdf/sanipe/v18n3/02_original.pdf Martin, M, S., Hynes, K., Hatcher, S., & Colman, I. (2016). Diagnostic error in correctional mental health: Prevalence, cause, and consequences. Journal of Correctional Health Care, 22(2), 109–117. doi:10.1177/1078345816634327 9 Moore, E., Sunjic, S., Kaye, S., Archer, V., & Indig, D. (2016). Adult ADHD among NSW prisoners: prevalence and psychiatric comorbidity. Journal of Attention Disorders, 22(11), 958–967. doi: 10.1177/1087054713506263 Nacher, M., Ayan, G., Arnal, R., Barsurko, C., Huber, F., Pastre, A., Jehel, L., Falissard, B., & About, V. (2018). High prevalence rates for multiple psychiatric conditions among inmates at French Guiana’s correctional facility: Diagnostic and demographic factors associated with violent offending and previous incarceration. BMC Psychiatry, 18, 159. doi:10.1186/s12888-018-1742-7 Naidoo, S., & Mkize, D. L. (2012). Prevalence of mental disorders in a prison population in Durban, South-Africa. African Journal of Psychiatry, 15(1), 30−35. doi:10.4314/ajpsy. v15i1.4 Osasona, S. O., & Koleoso, O. N. (2015). Prevalence and correlates of depression and anxiety disorder in a sample of inmates in a Nigerian prison. The International Journal of Psychiatry in Medicine, 50(2), 203−218. doi:10.1177/0091217415605038 Parsons, S., Walker, L., & Grubin, D. (2001). Prevalence of mental disorder in female remand prisons. Journal of Forensic Psychiatry, 12(1), 194−202. doi:10.1080/09585180122050 Sánchez, F. C., Zaragoza, J. N., Fearn, N. E., & Vaughn, M. G. (2017). The nexus of trauma, victimization, and mental health disorders among incarcerated adults in Spain. Psychiatric Quarterly, 88, 733–746. doi:10.1007/s11126-017-9493-z Sepehrmanesh, Z., Ahmadvand, A., Akasheh, G., & Saei, R. (2014). Prevalence of psychiatric disorders and related factors in male prisoners. Iranian Red Crescent Medical Journal, 16(1), 1−6. doi:10.5812/ircmj.15205 10 Solomon, A., Mihretie, G., & Tesfaw, G. (2019). The prevalence and correlates of common mental disorders among prisoners in Addis Ababa: An institution based cross- sectional study. BMC Research Notes, 12, 394. doi:10.1186/s13104-019-4425-7 Watzke, S., Ullrich, S., & Marneros, A. (2006). Gender- and violence-related prevalence of mental disorders in prisoners. European Archives of Psychiatry and Clinical Neuroscience, 256(7), 414−421. doi:10.1007/s00406-006-0656-4 Wetterborg, D., Langström, N., Andersson, G., & Enebrink, P. (2015). Borderline personality disorder: Prevalence and psychiatric comorbidity among male offenders on probation in Sweden. Comprehensive Psychiatry, 62, 63–70. doi:10.1016/j.comppsych.2015.06.014 Zabala-Baños, M. C., Segura, A., Maestre-Miquel, C., Martínez-Lorca, M., Rodríguez- Martín, B., Romero, D., & Rodríguez, M. (2016). Mental disorder prevalence and associated risk factors in three prisons of Spain. Revista Española de Sanidad Penitenciaria, 18, 13−23. doi:10.4321/S1575-06202016000100003 11 CHAPTER 2 PUBLISHABLE MANUSCRIPT Abstract Mental disorders are reportedly more prevalent in prisons than expected. The aim of this study was to determine the prevalence of mental disorders among offenders admitted at the health establishments in Bizzah Makhathe Correctional Centre, Kroonstad, South Africa. Structured psychiatric interviews were conducted to elicit the information. The majority of the participants were young males, black Africans with low educational levels, coming from low socio-economic backgrounds. Crimes against human beings were jointly the most common ones committed by the offenders. The lifetime prevalence of mental disorders was 54.7%. Personality disorders, followed by substance and addictive disorders were the most prominent disorders among the study sample. Other psychiatric disorders noted were depressive disorders, schizophrenia spectrum, intellectual disabilities and neurocognitive disorders, etc. It is agreed that a notable number of prisoners suffering from mental disorders goes undetected, undiagnosed and untreated. Constructs of competency to stand trial and criminal responsibility should always be observed. There is a need to conduct more empirical studies on the prevalence and incidences of mental disorders in correctional service centres in South Africa. Key words: prevalence, mental, disorders, correctional service centres, offenders, health facilities, diagnosis, crimes, demographics, psychiatric interview 12 Background International epidemiological studies have found that mental disorders are more common in correctional service centres than expected, with major psychiatric disorders being ten times more prevalent than in the general population (Andreoli et al., 2014). These findings are also supported by Watzke, Ullrich, and Marneros (2006), who pointed out that mental illness in prisons is particularly prevalent, and that the admission rate to correctional service establishments has increased in many countries over the past few years. Other authors such as Zabala-Baños et al. (2016) explain that this phenomenon of the high prevalence of mental disorders in prisons has affected the composition and typology of prison populations, as well as both criminal and behavioural patterns. Although the findings of epidemiological studies on mental health disturbances among prisoners may vary from country to country, the high prevalence of mental illness among prisoners remains the common factor. Data on the prevalence of mental illness in correctional service establishments is of utmost importance for the management of mental diseases, costing, planning and policy formulation by the departments of correctional services and health (Brown, Hirdes, & Fries, 2015). The available literature indicates that risk factors such as social exclusion and inadequate healthcare provisions in correctional service facilities largely contribute to the development of mental disorders in convicted offenders (López, Saavedra, López, & Laviana, 2016). There is a rapid growth in the admission rate of prisoners in the correctional service facilities across different countries, with about 10 million prisoners at any time across the globe. In light of these recently published statistics, the frequency of mental disorders in detained offenders has become a popular debated subject. Lafortune (2010) reports that although there has been a significant increase in the prison population in the last two decades, a large number of prisoners admitted with mental illnesses are undiagnosed and untreated, 13 most of which are missed on admission. The identification and treatment of mental disorders in detained offenders can be difficult if the disorder was missed on admission to correctional services (Graf et al., 2013). Based on the published literature, the high prevalence of mental illnesses among offenders has become a global concern. Correctional centres worldwide are populated with a burden of more than nine million prisoners (Sepehrmanesh, Ahmadvand, Akasheh, & Saei, 2014). Standardised routine screening of mental illness on admission could significantly reduce the number of untreated prison inmates and therefore ensure early psychiatric interventions (Parsons, Walker, & Grubin, 2001). Regarding the aforementioned background information, it can be said that mental illness in correctional service facilities may be a heavy burden for government budgets (Al-Rousan, Rubenstein, Sieleni, Deol, & Wallace, 2017). Generally, the provision of mental health services requires adequate and expensive physical and human resources. Sadly, undetected and untreated mental illnesses may result in fatal outcomes. Therefore, regular administration of screening tools in correctional facilities is of the utmost importance. The incidences of suicide among prisoners are reportedly higher in comparison to the general population (Osasona & Koleoso, 2015). This global occurrence of the marked prevalence of mental health issues will likely also affect South Africa. It is important to note that there is a dearth of data regarding the occurrence of mental disorders in South African correctional and rehabilitation facilities. Naidoo and Mkize (2012) write that South African correctional service centres are the most populated ones in Africa. In March 2015, South Africa had a total prison population of 159,241 according to the World Prison Brief, which ranked it 11th on a scale of the largest prisoner populations globally. It is against this background that the researchers decided to conduct a study on the prevalence of mental disorders in the Bizzah Makhate prison in Kroonstad, South Africa. 14 The South African government’s policy is that researchers should instead focus on their local communities in order to meet their needs; the principal researcher herself is part of the Kroonstad community. The documentation and description of the incidences and prevalence of mental disorders in correctional service centres will assist the government of South Africa in meeting the basic mental health needs of the inmates. Ethical Considerations Permission to conduct this study was obtained from the National Department of Correctional Services, Pretoria. The research was approved by the Health Sciences Research Ethics Committee (HSREC) of the University of the Free State (UFS). Informed consent was obtained from each participant, which was written in three of South African official languages (English, Afrikaans and Sesotho). Participants’ confidential information was used only for the purpose of the study, and the personal particulars of the participant are not reflected in any documents published. Aim of the Study The study aimed to determine the prevalence of mental disorders among offenders admitted at the health establishments in Bizzah Makhate Correctional Service Centre, Kroonstad, South Africa. In addition, participants’ socio-demographic characteristics and associated contributing factors were also studied. Research questions: • What is the prevalence of mental disorders among offenders admitted at health facilities in Bizzah Makhate Correctional Centre? • What are the socio-demographic characteristics of those offenders admitted in those facilities? • What are the crimes committed by those offenders? • Is there any association between the diagnoses and crimes? 15 Methodology The Moqhaka Municipality in South Africa was selected as a geographical area for the completion of this research, Bizzah Makhate Correctional Centre (formerly known as Kroonstad Prison) which accommodates 2 205 inmates. The study was conducted among offenders admitted at the health facilities within this correctional service centre. This was a quantitative, descriptive and empirical study. A systematic sampling technique was used for this purpose; systematic sampling is a sophisticated sampling method, which is practical when conducting a study in a population size where the researcher will not be including everyone but selecting possible candidates at equal intervals (Bless, Higson-Smith, & Sithole, 2015). Additionally, systematic sampling designs are commonly used methods which make data collection much more straightforward and are likely to guarantee less biased sample selection (Huang, 2004; Valentine, Affleck, & Gregoire, 2009). Verma, Singh, and Singh (2014) clarify that this method of sampling is simpler, convenient and efficient. It allows researchers to select a sample starting from a fixed point and to continue selecting possible participants at equal intervals. Taking into consideration the large number (800) of offenders being evaluated and treated (for various health conditions) monthly at the health facility of the Correctional Service centre concerned (Bizzah Makhate Prison). The study participants consisted of 150 sentenced offenders admitted at the health facilities, both in and out patient departments, of the prison in 2018. There were approximately 800 inmates admitted in October 2018. The researchers (mental health professionals) decided to select every 4th healthcare service user to be included in the study sample. Other inclusion criteria were that participants were supposed to be between 18 and 65 years old. Both genders were represented in the sample. Those who are gravely ill and those who were under 18 were excluded from 16 the study because they were not competent to give informed consent. Moreover, interviews were conducted; the duration of the study was six months. Instrument Structured psychiatric interviews were conducted to elicit data. The current literature indicates that structured psychiatric interviews are considered to be valid and reliable for modern research and clinical work (Nordgaard, Revsbech, Saebye, & Parnas, 2012). This type of research instrument provides data on preliminary identification including demographic information and examinees’ main complaints, personal description and history of illness (MacKinnon & Yudofsky, 1986; Nordgaard, Sass, & Parnas, 2013). The most crucial component of the psychiatric interview is the Mental Status Examination (MSE), which consists of physical appearance, attitude and behaviour, thought processes, perception, mood and affect, state of consciousness, orientation, memory, insight and judgment, tempo of speech, level of intelligence, mode of thinking, and both hypothalamic and autonomic functions. Lastly, it gives provision for diagnostic formulation. The authors used the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric Association [APA], 2013) and International Classification of Diseases, 10th edition (ICD-10; World Health Organisation [WHO], 1992) diagnostic criteria. The researchers conducted a pilot study on five participants in order to investigate the practical feasibility of the study and the validity and reliability of the psychiatric interview. Data Analysis The statistical and descriptive analyses were performed in the form of frequencies and percentages for the categorical data and means, standard deviations, medians and percentiles for the continuous data. Quantitative research is a method of collecting data and presenting through in numerical means such as tables, charts, graphs and statistics (O’Hara, Carter, Dewis, Kay, & Wainwright, 2011). 17 Results One hundred and fifty offenders participated in this scientific investigation. The sociodemographic characteristics of the participants are presented in Table 1. Table 1 Sociodemographic Characteristics Cumulative Cumulative Variable Frequency % Frequency Percentage Age 18-25 116 77.3 116 77.3 26-35 19 12.7 135 90.0 36-50 12 8.0 147 98.0 51-65 3 2.0 150 100.0 Sex Male 129 86.0 129 86.0 Female 21 14.0 150 100.0 Race Black 144 96.0 144 96.0 Caucasian 2 1.3 146 97.3 Coloured 4 2.7 150 100.0 Marital Status Single 125 83.3 125 83.3 Married 20 13.3 145 96.7 Divorced 3 2.0 148 98.7 Widowed 2 1.3 150 100.0 District Fezile Dabi 26 17.3 26 17.3 Lejweleputswa 72 48.0 98 65.3 Mangaung 20 13.3 118 78.7 Thabo Mofutsanyana 11 7.3 129 86.0 Xhariep 21 14.0 150 100.0 Education None 4 2.7 4 2.7 Grade 1-8 56 37.3 60 40.0 Grade 9-11 73 48.7 133 88.7 Grade 12 12 8.0 145 96.7 Undergraduate 2 1.3 147 98.0 Postgraduate 3 2.0 150 100.0 Employment status Unemployed/looking for job 29 19.3 29 19.3 Unemployed/not looking for job 33 22.0 62 41.3 Formal employment 6 4.0 68 45.3 Informal employment 33 22.0 101 67.3 Self-employed 10 6.7 111 74.0 Disability grant 4 2.7 115 76.7 Pensioners 35 23.3 150 100.0 18 The majority of the study sample consisted of males (86%), and mainly black Africans (96%) followed by coloured participants. More than 80% of the research population was composed of single individuals. Only 8% of the participants managed to obtain Grade 12 certificate. There are five districts in the Free State Province, namely Fezile Dabi, Lejweleputswa, Mangaung (the capital city of the province), Thabo Mofutsanyana and Xhariep; Bizzah Makhathe Correctional Centre is located in Fezile Dabi. However, 48% of the study sample originated from Lejweleputswa, the neighbouring district of Fezile Dabi. Participants’ history of unemployment before incarceration was relatively high, ranging around 40%. A marked portion of these prisoners were on a pension and/or social grant before imprisonment. The crimes committed by the study subjects are presented in Table 2. 19 Table 2 Crimes Frequency % Crimes Against a Person Assault 21 14.0 Murder 39 26.0 Hijacking 36 24.0 Attempted Murder 2 1.3 Rape 7 4.7 Kidnapping 6 4.0 Other 47 31.3 Crimes Against Property Fraud 1 0.7 Robbery 41 27.3 Burglary 34 22.7 Arson 2 1.3 Malicious Damage to Property 8 5.3 White-collar Crimes 1 16.7 Organised Crimes 5 83.3 Crimes Against the Community Drugs 16 10.7 Alcohol 1 0.7 Multiple Drug Use 5 3.3 Illegal Drug Business 1 0.7 Sex-related Crimes 1 0.7 Public Violence 15 10.0 Possession of Illegal Firearm 4 2.7 Other 3 2.0 Crimes against other human beings dominated the distribution of the offences among the sample. The researchers are referring to criminal acts such as robbery (27.3%), murder (26.0%), motor vehicle hijacking (24.0%) and assaults (14.0%), which are crimes 20 characterised by aggression and violence. Some prisoners were convicted of rape (4.7%) and kidnapping (4.0%). As far as property crime is concerned, it was found that burglary and malicious damage to property were common criminal acts. A notable portion of the study population was convicted of substances-related crimes like illegally dealing with alcohol and drugs, while 10.0% of the prisoners were found guilty of public violence crimes. Psychiatric diagnoses among the offenders are depicted in Table 3. Table 3 Psychiatric Diagnosis Disorders Frequency % Prevalence of Mental Disorders 82 54.7 Intellectual Disability 7 4.7 Schizophrenia Spectrum 9 6.0 Bipolar and Related Disorders 4 2.7 Depressive Disorders 12 8.0 Neurocognitive Disorders 4 2.7 Personality Disorders 38 25.3 Substance and addictive disorders 23 15.3 Anxiety Disorders 1 0.7 As reflected in Table 3, it was found that the current prevalence of mental disorders among the prisoners was 54.7% according to DSM-5 criteria. Besides the high prevalence of personality disorders among the participants, the second prevalent diagnosis was substance and addictive disorders, accounting for 15.3% of participants. The researchers also found the notable prevalence of major depressive disorder (8.0%) and schizophrenia spectrum and other psychotic disorders at the rate of 6.0%, while 4.7% of the study population was diagnosed with intellectual disabilities. The least prevalent mental disorders were anxiety, (0.7%) and neurocognitive, bipolar and related disorders (2.7%). Regarding comorbidity, it 21 was found that that 8.7% of the participants who were diagnosed with personality disorders, had comorbidity of substance related and addictive disorders. There were also minor comorbid manifestations of personality and neurocognitive disorders among those who were suffering from depressive disorders and schizophrenia. Discussion The results of the study illustrate that young males are more vulnerable to committing crimes; this referred to individuals aged between 18 and 35. The finding is in accordance with what was reported by Diamond, Wang, Holzer III, Thomas, and des Anges Cruser (2001), who also reported the same trend in the US. At the time of the assessment, it was also noted that the majority of the prisoners were of single marital status, most of whom were black Africans. These results are not surprising, and are proportional to the population distribution of South Africa according to the 2011 Census (Statistics South Africa, 2012). The mental status among the prisoners in Bizzah Makhate Correctional Service is markedly different from what was reported in Spain. In Spanish prisons, Vicens et al. (2011) found that 44.0% of their study participants were single in comparison with what was found in this study, whereby more than 80% of the offenders were of single marital status. Regarding educational levels, it was found that the majority of the prisoners participating in this study did not complete grade 12 (secondary/high school education). This might be the reason why the majority of these participants were not formally employed due to their lack of skills required in the labour market. In this study, one surprising finding was that the large portion of this prisoner population was from Lejweleputswa rather than Fezile Dabi, where the centre is geographically located. In general, the socio-demographic characteristics of the participants in this study, in terms of age, gender, education levels and unemployment at the time of their incarceration, is similar to what was reported in Spain by Zabalar-Baños et al. (2016). 22 It is a worrying factor that the majority of crimes were directed at other human beings. In this study, it was found that the assault, murder, robbery and motor vehicle hijacking rates were high. These forms of crimes, especially assault and murder, were also reported in Germany by other authors such as Watzke et al. (2006). It was also found that more females than males were found guilty of murder and assault, while sex-related crimes were only perpetuated by men. As far as robbery is concerned, both men and women were almost equally responsible for this type of crime, while motor vehicle hijacking was committed by men only. The researchers’ opinions are that the violent crimes committed by both genders is worrying. Furthermore, both male and female prisoners were almost equally criminally responsible for malicious damage to property. Regarding mental disorders and the nature of the crimes, individuals diagnosed with intellectual disabilities were more often accused of rape (28.0%) and assault (15.0%), while those who were suffering from schizophrenia were also more likely to commit violent and aggressive crimes such as assault (33.0%), rape (28.4%) and murder (25.0%). Those who presented with bipolar and related disorders were mostly involved in malicious damage to property and burglary, when combined accounted for 72.0% of all crimes. Assault was more commonly committed by females than males diagnosed with bipolar mood disorders; 27.4% of males diagnosed with bipolar and related disorders were found guilty of sex-related crimes, especially rape. The notable prevalence of mental disorders among the participants in Bizzah Makhate Correctional Service Centre is of great concern to the researchers. It has been documented by various forensic mental health professionals that a mental illness itself may affect the faculties of competency to stand trial and the associated criminal responsibility. The finding that the prevalence of mental disorders was more than 50% is of marked concern. The fact that a marked portion of this study sample was diagnosed with mental disorders such as schizophrenia spectrum disorders and other psychotic disorders, 23 bipolar and related disorders, intellectual disabilities and neurocognitive disorders is a worrying factor regarding the administration of criminal justice. In South African Criminal Procedure Act 51 of 1977, Sections 77 (competency to stand trial), 78 (criminal responsibility) and 79 (psychiatric report on the mental status of the accused), (Department of Justice and Constitutional Development, 1997) dictates that people appearing before courts of law should be able to understand and follow legal proceedings and must have the mental capacity to understand the charges before them and be able to give sound instructions to their defence team. The researchers in this study wonder whether the participants who were diagnosed with intellectual disabilities and schizophrenia were fairly adjudicated by the criminal justice system before being sentenced to prison. Conclusion The results of this study confirmed what has been reported in the international literature: mental disorders are common in prison populations. It was found that prisoners at the correctional service centre studied were generally young males of a low socio-economic status. Furthermore, the criminal acts committed were mainly directed at human beings rather than at property. Severe mental disorders such as substance abuse/use disorders, personality disorders, mood disorders (such as major depressive disorder), intellectual disabilities and schizophrenia were found to be relatively prevalent among this study population. The researchers argue that a large number of admitted offenders with mental disorders go undetected, undiagnosed and untreated, as is the case in Bizzah Makhate Correctional Service Centre. The authors recommend the standardised routine screening of the signs and symptoms of mental illness during admission. Early detection and intervention may facilitate the better management of mental disorders in prisons. This will help reduce the possibility of violent and suicidal behaviours among the inmates. It is also recommended that prisoners presenting with intellectual disabilities be placed in special designated units because they are 24 vulnerable to abuse and other forms of exploitation by the hardcore criminal elements in these centres. Additionally, the criminal justice system should always take into consideration the constructs of competency to stand trial and criminal responsibility before sentencing the alleged offenders. The study provides a general picture of the prevalence and incidence of mental health issues in correctional service centres in South Africa. Moreover, it will contribute to the international literature regarding the subject of mental health among prison populations. Furthermore, the study has the capacity to assist policymakers and managers to meet the primary mental health needs of the offenders. Although the study provides valuable information on mental disorders in prisons, it should, however, be interpreted with caution as far as a generalisation is concerned, taking into consideration the small study sample and restricted area of research. The study was conducted in health establishments within the Bizzah Makhate Correctional Centre and therefore did not cover the whole prisoner population in this centre. One of the study limitations was that no special medical investigations were conducted which might have affected the holistic outcome of the study. Further more, there was no information that any of the participants (offenders) were ever referred for forensic mental examination. Lastly, access rules and regulations at the correctional service centres in South Africa, should be relaxed, and be user-friendly in order to allow academics and scientists to be able to easily conduct scientific research in this facilities. 25 References Al-Rousan, T., Rubenstein, L., Sieleni, B., Deol, H., & Wallace, R. B. (2017). Inside the nation’s largest mental health institution: a prevalence study in a state prison system. BioMed Central Public Health, 17(342), 1−9. doi:10.1186/s12889-017-4257-0 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Washington, DC: Author. Andreoli, S. B., dos Santos, M. M., Quitana, M. I., Ribeiro, W. S., Blay, S. L., Taborda, J. G. V., & de Jesus Mari, J. (2014). Prevalence of mental disorders among prisoners in the State of Sao Paulo, Brazil. Public Library of Science, 9(2), 1−7. doi:10.1371/journal.pone.0088836 Bless, C., Higson-Smith, C., & Sithole, S. L. (2015). Fundamentals of social research methods: an African perspective (5th ed.). Cape Town, South Africa: Juta & Company Ltd. Brown, G. P., Hirdes, J. P., & Fries, B. E. (2015). Measuring the prevalence of current, severe symptoms of mental health problems in a Canadian correctional population: Implications for delivery of mental health services for inmates. International Journal of Offender Therapy and Comparative Criminology, 59(1), 27−50. doi:10.1177/0306624X13507040 Department of Justice and Constitutional Development. (1997). Criminal Procedure Act 51 of 1977, amendment 86 of 1996. Cape Town, South Africa: Juta & Company Limited. Diamond, P. M., Wang, E. W., Holzer III, C. E., Thomas, C., & des Anges Cruser. (2001). The prevalence of mental illness in prison. Administration and Policy in Mental Health, 29(1), 21−40. doi:10.1023/A:1013164814732 Graf, M., Wermuth, P., Häfeli, D., Weisert, A., Reagu, S., Pflüger, M., Taylor, P., Dittmann, V., & Roland, J. (2013). Prevalence of mental disorders among detained asylum 26 seekers in deportation arrest in Switzerland and validation of the Brief Jail Mental Health Screen BJMHS. International Journal of Law and Psychiatry, 36, 201−206. doi:10.1016/j.ijlp.2013.04.009 Huang, K. (2004). Mixed random systematic sampling designs. Metrika, 59, 1−11. doi:10.1007/s001840300264 Lafortune, D. (2010). Prevalence and screening of mental disorders in short-term correctional facilities. International Journal of Law and Psychiatry, 33(2), 94−100. doi:10.1016/j.ijlp.2009.12.004 López, M., Saavedra, F. J., López, A., & Laviana, M. (2016). Prevalence of mental health problems in sentenced men in prison from Andalucìa (Spain). Revista Española de Sanidad Penitenciaria, 18, 76−84. Retrieved from http://scielo.isciii.es/pdf/sanipe/v18n3/02_original.pdf MacKinnon, R. A., & Yudofsky, S. C. (1986). The Psychiatric Evaluation in Clinical Practice. Philadelphia, PA: J. B. Lippincott. Nordgaard, J., Revsbech, R., Saebye, D., & Parnas, J. (2012). Assessing the diagnostic validity of structured psychiatric interview in a first-admission hospital sample. World Psychiatry, 11, 181−185. doi:10.1002/j.2051-5545.2012.tb00128.x Nordgaard, J., Sass, L. A., & Parnas, J. (2013). The psychiatric interview: validity, structure, and subjectivity. European Archives of Psychiatry & Clinical Neuroscience, 263(4), 353−364. doi:10.1007/s00406-012-0366-z Naidoo, S., & Mkize, D. L. (2012). Prevalence of mental disorders in a prison population in Durban, South-Africa. African Journal of Psychiatry, 15(1), 30−35. doi:10.4314/ajpsy.v15i1.4 27 O’Hara, M., Carter, C., Dewis, P., Kay, J., & Wainwright, J. (2011). Successful dissertations: The complete guide for education, childhood and early childhood studies students. New York, NY: Continuum International Publishing Group. Osasona, S. O., & Koleoso, O. N. (2015). Prevalence and correlates of depression and anxiety disorder in a sample of inmates in a Nigerian prison. The International Journal of Psychiatry in Medicine, 50(2), 203−218. doi:10.1177/0091217415605038 Parsons, S., Walker, L., & Grubin, D. (2001). Prevalence of mental disorder in female remand prisons. Journal of Forensic Psychiatry, 12(1), 194−202. doi:10.1080/09585180122050 Sepehrmanesh, Z., Ahmadvand, A., Akasheh, G., & Saei, R. (2014). Prevalence of psychiatric disorders and related factors in male prisoners. Iranian Red Crescent Medical Journal, 16(1), 1−6. doi:10.5812/ircmj.15205 Statistics South Africa. (2012). Census 2011. Author. Retrieved from https://www.statssa.gov.za/publications/P03014/P030142011.pdf Valentine, H. T., Affleck, D. L. R., Gregoire, T. G. (2009). Systematic sampling of discrete and continuous populations: sample selection and the choice of estimator. Canadian Journal of Forest Research, 39, 1061−1068. doi:10.1139/X09-019 Verma, H. K., Singh, R. D., & Singh, R. (2014). Some improved estimators in systematic sampling under non-response. National Academy Science Letters, 37(1), 91−95. doi:10.1007/s40009-013-0192-5 Vicens, E., Tort, V., Dueñas, R. M., Muro, Á., Pérez-Arnau, F., Arroyo, J. M.,…Sarda, P. (2011). The prevalence of mental disorders in Spanish prisons. Criminal Behaviour and Mental Health, 21, 321−332. doi:10.1002/cbm.815 28 Watzke, S., Ullrich, S., & Marneros, A. (2006). Gender- and violence-related prevalence of mental disorders in prisoners. European Archives of Psychiatry and Clinical Neuroscience, 256(7), 414−421. doi:10.1007/s00406-006-0656-4 World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva, Switzerland: Author. Zabala-Baños, M. C., Segura, A., Maestre-Miquel, C., Martínez-Lorca, M., Rodríguez- Martín, B., Romero, D., & Rodríguez, M. (2016). Mental disorder prevalence and associated risk factors in three prisons of Spain. Revista Española de Sanidad Penitenciaria, 18, 13−23. doi:10.4321/S1575-06202016000100003 29 APPENDICES A. LETTER OF APPROVAL FROM HEALTH SCIENCES RESEARCH ETHICS COMMITTEE B. RESEARCH APPLICATION DOCUMENTS FROM THE CORRECTIONAL SERVICES DEPARTMENT OF CORRECTIONAL SERVICES RESEARCH IN THE DEPARTMENT OF CORRECTIONAL SERVICES INSTRUCTIONS: 1. This form caters for research carried out by a team or an individual 2. Please complete in PRINT-Using blank ink 3. Mark with an X where applicable 4. Please attach the following documents to your application: (I) A detailed research proposal and proposed method (ii) Certified copies of your ID Book(s)/ Passport(s) (iii) Current proof of registration from the institution where you are studying (Students only) A. PERSONAL INFORMATION A1: For research conducted by an individual (Note: If it is a research by a team of individuals details of the team leader should also be included here) 1) Title ___________2) Surname _________________________________________________3) Initials _________________ 4) Full Name(s)__________________________________________________5) ID Number 6) Country of Origin ____________________________________________________________________________________ If not a S.A. Citizen: Passport No A2: For research conducted by a team of individuals 7) Details of team members must be completed in the table below (If more than five include others on the separate sheet) Surname Initials ID/ Passport Number Highest Qualification Obtained 1. 2. 3. 4. 5. 8) Postal Address: 12) Residential Address: Code: Code: 9) [H] Telephone No: Area Code: 13)[W] Telephone No: Area Code: Number: Number: 10) Fax Number: Area Code: 14) Cellular Phone Number: Number: 11) E-Mail Address: 15) Academic Qualifications Diploma / Degree/Certificate Institution Date obtained 16) Present Employer __________________________________________________________________________________ 17) Position Occupied __________________________________________________________________________________ 18) If you are a member of the Department of Correctional Services: Persal Number 19) Station ___________________________________________________________________________________________ B. INDIVIDUAL/GROUP’S PREVIOUS RESEARCH AND/OR PUBLICATIONS 20) Title 21) Publisher 22) Magazine 23) Date C. PLANNED RESEARCH 24) Title _____________________________________________________________________________________________ 25) Is your planned research required to obtain a qualification? * Yes No If yes, specify field of study______________________________________________________________________________ ____________________________________________________________________________________________________ If no, stipulate purpose of research _______________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 26) Does your planned research have any connection with your present field of work? * Yes No 27) Subject to the conditions that may be set in this regard, do you intend to publish or orally present the findings of your research/ dissertation/ thesis or parts thereof during lectures/ seminars? * Yes No If yes, in which way, and at what stage? ____________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 28) At which Area(s) of Command/ Prison(s) do you plan to do your research? ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ ___________________________________________ 29) Which of the following will be involved in your research? Yes No Specify Offenders Personnel Official documents of the Department Interviews Questionnaires Observations Psychometric tests Technological Devices Yes No Specify Medical Tests including: • Physical Assessment • Laboratory tests (blood, sperm, urine) • X-ray examination • Other D. SUPPLEMENTARY INFORMATION 30) For which tertiary institution/ Organisation/ Company are you conducting the research? ____________________________ _____________________________________Department/ Division/ Section/ Component/ Unit ________________________ ________________________________________________Project or Group Leader/ Promoter/ Lecturer: Title_____________ 31) Surname ____________________________________________ Initials __________ 32) What value is your planned research to the Department of Correctional Services? _________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 33) Do you receive any financial assistance for your planned study in the form * of a Scholarship / Loan/ Bursary/ Sponsor? Yes No If yes, do your sponsor/ loaner/ funder have any copyrights to the study? If yes specify__________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ E. COMMENTS/ RECOMMENDATIONS OF THE CHAIR PERSON OF THE RESEARCH ETHICS COMMITTEE ACADEMIC INSTITUTION’S WITH REGARD TO THE APPLICATION _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 34) Title ___________ 35) Surname __________________________________________________36) Initials _____________ __________________________ __________________________ Signature Date Official stamp of the Institution/ Organization/ Company F. DECLARATION STATEMENT BY APPLICANTS: I/We confirm that: 1. the particulars mentioned above are true, and 2. if this application is favourably considered, I/ We will comply with the conditions which may be set with regard to the application. Note: If it is a research carried by a team, the Team Leader’s signature must appear on the space provided below together with the signatures of two other members of the team as witnesses. ____________________________ ______________________________ ___________________________ Applicant/Team Leader’s Signature Witness’s Signature Witness’s Signature ____________________________ ______________________________ ___________________________ Date Date Date FOR OFFICE USE BY HEAD OFFICE ONLY In case of Bursary Holders of the Department of Public Service and Administration please refer to the Director: Policy and External Training Referred by _______________________________________________ Date ___________________________ Application * APPROVED AMENDED NOT APPROVED ___________________________________________ ___________________________ Chairperson: Research Ethics Committee Date I (name & surname) wish to conduct research titled in/at institutions which falls under the authority of the National Commissioner of Correctional Services. I undertake to use the information that I acquire in a balanced and responsible manner, taking in account the perspectives and practical realities of the Department of Correctional Services (hereafter referred to as “the Department”) in my report/treatise. I furthermore take not of and agree to adhere to the following conditions: 1.1 INTERNAL GUIDE The researcher accepts that an internal guide, appointed by the Department of Correctional Services will provide guidance on a continual basis, during the research. His/her duties will be: 1.1.1 To help with the interpretation of policy guidelines. He/she will therefore have to ensure that the researcher is conversant with the policy regarding functional areas of the research. 1.1.2 To help with the interpreting of information/statistics and terminology of the Department which the researcher is unfamiliar with. 1.1.3 To identify issues which could cause embarrassment to the Department, and to make recommendations regarding the utilization and treatment of such information? 1.1.4 To advise Correctional Management regarding the possible implementation of the recommendations made by the researcher. With regard to the abovementioned the research remains the researchers own work and the internal guide may therefore not be prescriptive. His/her task is assistance and not to dictate a specific train of thought to the researcher. 1.2 GENERAL CONDITIONS WHEN DOING RESEARCH IN PRISONS 1.2.1 All external researchers; before conducting research must familiarize themselves with guidelines for the practical execution of research in prisons as contained in the handbook (see par.11 of Research Policy). 1.2.2 Participation in the research by members/offenders must be voluntary, and such willingness must be indicated in writing. 1.2.3 Offenders may not be identified, or be able to be identified in any way. 1.2.4 Research Instrument such as questionnaires/schedules for interviews must be submitted to the Department (internal guide) for consideration before they may be used. 1.2.5 The Department (Internal Guide) must be kept informed of progress and the expected completion dates of the various phases of the research an progress reports/copies of completed chapters furnished for consideration to the Department should this be requested by the Department. 1.2.6 The Research Ethics Committee of the DCS must be provided with soft copy and two hard copies of the researcher’s report. 1.2.7 The Researcher’s report must be submitted for evaluation two months prior to presentation and publication for the National Commissioner’s approval (see par.9 of Policy). 1.2.8 Research findings or any other information gained during the research may not be published or made known in any other manner without the written permission of the Commissioner of Correctional Services. 1.2.9 A copy of the final report/essay/treatise/thesis must be submitted to the Department for further use. 1.2.10 Research will have to be done in the researchers own time and at his own cost unless explicitly stated otherwise at eh initial approval of the research. 1.3 CONDUCT IN CORRECTIONAL CENTRES 1.3.1 Arrangements to visit a correctional centre (s) for research purposes must be made with the Area Manager of that particular centre. Care should be taken that the research be done with the least possible disruption of offender’s routine. 1.3.2 Office space for the conducting of tests and interviews must be determined in consultation with the Area Manager of that particular centre. 1.3.3 Research instruments/interviews must be used/ done within view and hearing distance of a member (s) of the South African Correctional Services. 1.3.4 Documentation may not be removed from files or reproduced without the prior approval of the Area Manager of the Centre. 1.3.5 Any problem experienced during the research must be discussed with the relevant Head of the Correctional centre without delay. 1.3.6 Identification documents must be produced at the centre upon request and must be worn on the person during the visit. 1.3.7 Weapons or other unauthorized articles may not be taken into the correctional centre. 1.3.8 Possession of the Researcher taken into the correctional centre and other necessary articles that are worn on the researcher’s person are at his own risk. Nothing may be handed over to the offenders except that which is required for the process of research; e.g. manuals, questionnaires, stationery, etc. 1.3.9 The research must be done in such a manner that offenders /members cannot subsequently use it to embarrass the Department of Correctional Services. 1.3.10 Researchers must be circumspect when approaching offenders with regard to their appearance and behavior, and researchers must be careful of manipulation by offenders. The decision of the Head of Centre in this regard is final. 1.3.11 No offender may be given the impression that his/her co-operation could be advantageous to him/her personality. 2. INDEMNITY The researcher waivers any claim which he may have against the Department of Correctional Services and indemnifies the Department against any claims, including legal fees at an attorney and client scale which may be initiated against the latter by any other person, including a offender. 3. CANCELLATION The National Commissioner of Correctional Services retains the right to withdraw and cancel authorization or research at any time, should the above conditions not be adhered to or the researcher not keeps to stated objectives. In an event of the researcher deciding to discontinue the research, all information and data collected from the liaison with the Department must be returned to the Department and such information may not be published in any other publication without the permission of the National Commissioner of Correctional Services. The National Commissioner of Correctional Services also retains the right to allocate the research to another researcher. 4. SUGGESTIONS The researcher acknowledges that no other suggestions except those contained in this agreement; were made which had led him/her to the entering into this agreement. Signed at on the day of month year. RESEARCHER: WITNESSES Above-mentioned researcher signed this agreement in my presents. Name & Surname: Date: ENDORSEMENT BY PROMOTER OR EMPLOYER OF THE RESEARCHER WHERE APPLICABLE I have taken cognizance of the contents of this agreement and do not have any reservation with the conditions of this agreement. Signature: C. APPROVAL LETTER FROM DEPARTMENT OF CORRECTIONAL SERVICES D. PERMISSION LETTER FROM HEAD OF DEPARTMENT E. COPY OF RESEARCH PROTOCOL APPROVED BY HEALTH SCIENCES RESEARCH ETHICS COMMITTEE The prevalence of Mental Disorders among offenders admitted at health facilities in Bizzah Makhate Correctional Service Centre, Kroonstad, South-Africa. Introduction International epidemiological studies have found that mental disorders are more common in correctional service centres than expected, with major psychiatric disorders being 10 times more prevalent than in the general population (Andreoli et al., 2014). These findings are also supported by Watzke, Ullrich, and Marneros, (2006), who point out that mental illness in prisons are prevalent; and the admission rate to correctional service establishments has increased in many countries over the past few years. Other authors such as Zabala-Baños et al., (2016) explain that due to this phenomenon of high prevalence of mental disorders in prisons, it has affected the composition and typology of prison populations, criminal and behavioural patterns. Although the findings of the epidemiological studies on mental health disturbances among prisoners may vary from country to country, the high prevalence of mental illness among prisoners still remain the common factor. Data on the prevalence of mental illness in the correctional service establishments is of utmost importance for the management of mental diseases, costing, planning and policy formulation by the departments of correctional services and health (Brown, Hirdes, & Fries, 2015). Literature indicates that risk factors such as social exclusion and inadequate health care provisions in correctional service facilities also contribute largely to the development of mental disorders in convicted offenders (López, Saavedra, López, & Laviana, 2016). There is a rapid growth in the admission rate of prisoners in the correctional service facilities across different countries, with about 10 million prisoners at a time world-wide. With recent published statistics the prevalence of mental disorders in detained offenders has become a common debated subject. Lafortune (2010) reports that although there has been a significant increase in the prisons population in the last two decades, a large number of admitted prisoners with mental illness are undiagnosed and untreated, most which are missed on admission. Identification and treatment of mental disorders in detained offenders can be difficult if the disorder was missed on admission to correctional services (Graf et al., 2013). Based on the published literature, the high prevalence of mental illnesses among offenders has become a global concern. Correctional centers worldwide are populated with a burden of more than 9million prisoners (Sepehrmanesh et al., 2014). Standardized routine screening of mental illness on admission can significantly reduce the number of untreated prison inmates and therefore ensure early psychiatric interventions (Parsons, Walker, & Grubin, 2001). Regarding the above given background information, it can be said that mental illness in correctional service facilities may be one of the budget burdens for the governments (Al-Rousan et al., 2017). Provision of mental health services in general, require adequate and expensive physical and human resources. The undetected and untreated mental illnesses may result in fatal outcomes, therefore, regular administration of screening tools in correctional facilities is of utmost importance. The incidences of suicide among prisoners are reportedly higher in comparison with general population (Osasona & Koleoso, 2015). This global occurrence of marked prevalence of mental health issues should be affecting South Africa as well. It is important to note that there is dearth of data regarding the prevalence of mental disorders in South African correctional and rehabilitation facilities. Naido & Mkize (2012) write that South African correctional service centres are the most populated ones in Africa. In March 2015 South Africa had a total prison population of 159,241 according to the World Prison Brief, which placed it among the 11th with the largest prisoner populations globally. It is against this background that the principal researcher decided to conduct a study on the prevalence of mental disorders in South African prison, Bizzah Makhate, in Kroonstad. The South African government policy is that the researchers should rather focus on their local communities in order to meet the needs of the communities. The principal herself is part of the Kroonstad community. The documentation and description of the incidences and prevalence of mental disorders in correctional service centres will assist the government of South Africa in meeting the basic needs of mental health services of the inmates. Aim of the study The aim of the study is to determine the prevalence of mental disorders among offenders admitted at the health establishment of the correctional service centers in Bizzah Makhate, Kroonstad, South Africa. In addition, the socio-demographic characteristics and contributing factors will also be determined. Methodology Moqhaka Municipality in South Africa is selected as a geographical area for the completion of this research. The study will be conducted among offenders, at the health facilities within the correctional service centre, in Bizzah Makhate Prison, Kroonstad, South Africa. This is a descriptive and empirical study. Systematic sampling technique will be used for this purpose. Systematic sampling is one of the sophisticated methods of sampling that is practical when conducting a study in a population size where researcher will not be including everyone, but selecting each possible candidate at equal intervals (Bless, Higson-Smith & Sithole, 2015). Additionally, systematic sampling designs are commonly used methods which make data collection much simpler and likely to guarantee less biased sample selection (Huang, 2004; Valentine, Affleck, & Gregoire, 2009). Verma, Singh and Singh (2014), clarify that this method of sampling is much simpler, convenient and efficient. It allows the researcher to select a sample starting from a fixed point and to continue selecting possible participants at equal intervals. Taking into consideration the large number (80 offenders) being evaluated and treated daily at the health facility of the Correctional Service centre concerned (Bizzah Makhate Prison); the researcher has decided to select every 4th health care service user to be included in the study sample. Other inclusion criteria are that participants must be aged between 18 and 65 years. Both genders will be represented in the sample. The researcher aims to evaluate approximately 150 participants/offenders. Those who are gravely ill and juveniles will be excluded from the study. The interviews will be conducted after their clinic consultation. The duration of the study is estimated to be within 6 months. Methodological Error For safety and control purposes the study will be conducted at the prison hospital. We also acknowledge that the screened sample may not represent the whole prison population. Instrument Structured psychiatric interview will be conducted to elicit data. Current literature indicates that structured psychiatric interview is considered to be valid and reliable for modern research and clinical work (Nordgaard, Revbech, Saebye & Parnas, 2012). This type of research instrument provides data on preliminary identification including demographic information, main complaint by the examinee, personal description and history of illness (MacKinnon & Yudofsky, 1986; Nordgaard, Sass & Parnas, 2013). The most important component of psychiatric interview is the Mental Status Examination (MSE), which consists of physical appearance, attitude & behaviour, thought processes, perception, mood and affect, state of consciousness, orientation, memory, insight and judgment, tempo of speech, level of intelligence, mode of thinking, and both hypothalamic and autonomic functions. And lastly it gives provision for diagnostic formulation. It has been decided to use DSM-5 (APA, 2013), and ICD-10 (WHO, 1992) diagnostic criteria. Data Analysis The statistical analysis will be performed by the department of Biostatistics, University of the Free-State. Descriptive statistics namely, frequencies and percentages for categorical data, and means and standard deviations or medians and percentiles for continuous data, will be used. Pilot Study The researcher will conduct a Pilot study on 5 participants in order to investigate the practical feasibility of the study, validity and reliability of psychiatric interview. If no changes are needed on the questionnaire or methodology these information collected will be included in the main study. Significance of the study There is no sufficient information on the prevalence of mental illnesses in South African correctional centres. This study will provide information and data on the impact and prevalence of mental disorders in these institutions. Further more it will assist policy makers and managers to meet the basic mental health needs of the offenders. It will also contribute markedly to the international literature as far as provision of mental health services in the correctional facilities is concerned. Ethics approval Permission to conduct this study will be requested from the regional offices of the Department of Correctional Services. The final ethical approval will be solicited from Health Sciences Research Ethics Committee of the University of the Free State. The informed consent will be obtained from each participant which will be in 3 official languages (English, Afrikaans and Sesotho). The participant’s confidential information will be used only for the purpose of the study, and the personal particulars of the participant will not be reflected in any documents to be published. Time schedule Literature review October 2016-November 2017 Planning and Protocol writing November 2017 Health Sciences Research Ethics Committee November 24 2017 Conduction of pilot study April 2018 Data collection April- June 2018 Analysis July- September 2018 Report writing October- December 2018 Budget The study will be funded by the researcher herself. And the budget estimates are as follows: Transport R3500 Printing of psychiatric interview R2000 Stationery R500 Total R6000 References: Al-Rousan ,T., Rubenstein, L., Seileni, B., Deol, H., & Wallace, R.B. (2017). Inside The nation’s largest mental health institution: a prevalence study in a state prison system. BioMed Central Public Health, 17,342,1-9. doi: 10.1186/s 12889-017-4257-0 American Psychiatry Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Washington, DC: Author. Andreoli, S.B., Dos Santos, M.M., Quitana, M.I., Ribeiro, W.S., Blay, S.L., Taborda, J.G.V., & de Jesus Mari, J. (2014). Prevalence of Mental Disorders among Prisoners in the State of Sao Paulo, Brazil. Public Library of Science, 9(2),1-7. Bless, C., Higson-Smith, C., & Sithole, S.L. (2015). Fundamentals of social research methods: an African perspective, 5th Ed. Cape Town, SA: Juta & Company Ltd. Brown, G.P., Hirdes, J.P., & Fries, B.E. (2015). Measuring the Prevalence of Current, Severe Symptoms of Mental Health Problems in a Canadian Correctional Population: Implications for Delivery of Mental Health Services for Inmates. International Journal of Offender Therapy and Comparative Criminology, 59(1),27-50. Graf, M., Wermuth, P., Häfeli, D., Weisert, A., Reagu, S., Pflüger, M., Taylor, P., Dittmann, V., & Roland, J. (2013). Prevalence of mental disorders among detained asylum seekers in deportation arrest in Switzerland and validation of the Brief Jail Mental Health Screen BJMHS. International Journal of Law and Psychiatry, 36,201-206. Huang, k. (2004). Mixed random systematic sampling designs. Metrika, 59,1-11. doi 10.1007/s001840300264 Lafortune, D. (2010). Prevalence and screening of mental disorders in short-term correctional facilities. International Journal of Law and Psychiatry, 33,94-100. López, M., Saavedra, F.J., López, A., & Laviana, M. (2016). Prevalence of Mental Health problems in sentenced men in prison from Andalucìa (Spain). Revista Espanola De Sanidad Peniteñaaria, 18,76-84. MacKinnon, R.A & Yudofsky, S.C (1996). The Psychiatric Evaluation in Clinical Practice. Philadelphia:J.B. Lippincott. Nordgaard, J., Revbech, R., Saebye, D., & Parnas, J. (2012). Assessing the diagnostic validity of structured psychiatric interview in a first-admission hospital sample. World Psychiatry, 11,181-185. Nordgaard, J., Sass, L.A., & Parnas, J. (2013). The psychiatric interview: validity,structure, and subjectivity. European Archives of Psychiatry & Clinical Neuroscience, 263,353- 364. doi: 10.1007/s 00406-012-0366-z Naido, S., & Mkize, D.L. (2012). Prevalence of mental disorders in a prison population in Durban, South-Africa. African Journal Psychiatry,15,30-35. Osasona, S.O., & Koleoso, O.N. (2015). Prevalence and correlates of depression and anxiety disorder in a sample of inmates in Nigerian prison. The International Journal of Psychiatry in Medicine, 50(2), 203-218. Parsons, S., Walker, L., & Grubin, D. (2001). Prevalence of mental disorder in female remand prisons. The Journal of Forensic Psychiatry, 12(1), 194-202. Sepehrmanesh, Z., Ahmadvand, A., Akasheh, G., & Saei, R. (2014). Prevalence of Psychiatric Disorders and Related Factors in Male Prisoners. Iranian Red Crescent Medical Journal,16(1),1-6. doi:10,5812/ircmj.15205. Valentine, H.T., Affleck, D.L.R., Gregoire, T.G. (2009). Systematic sampling of discrete and continuous populations: sample selection and the choice of estimator. Canadian Journal of Forest Reserch, 39,1061-1068. doi: 10.1139/X09-019 Verma, H.K., Singh, R.D., & Singh, R. (2014). Some improved estimators in systematic sampling under non-response. National Academy Science Letters, 37,91-95. Watzke, S., Ullrich, S., & Marneros, A. (2006). Gender-and- Violence-related prevalence of mental disorders in prisoners. European Archives of Psychiatry & Clinical Neuroscience, 256, 414-421. doi: 10.1007/s00406-006-0656-4. World Health Organization. (1992). The International Classification of Disease (10th ed.) Geneva, Switzerland: Author. Zabala-Baños, M.C., Segura, A., Maestre-Miquel, C., Martínez-Lorca, M., Rodríguez- Martín, B., Romero, D., & Rodríguez, M. (2016). Mental disorder prevalence and associated risk factors in three prisons of Spain. Revista Espanola De Sanidad Peniteñaaria, 18,76-84 Informed consent Dear participant, You are hereby invited to take part in a study on the prevalence of mental disorders in correctional services. Your answers will help us document the extent of mental health disturbances among offenders in this centre. The interview may from time to time upset you, and you are free to stop and withdraw at anytime. You may also refuse to answer any question if you feel so. Your refusal or withdrawal from the study will not, in any manner, affect the quality of services you are entitled to in this establishment. Your responses will be used for the purpose of the study only. All responses will be kept confidential. Thank you Participant’s signature ………………………. Date ………………………. Researcher’s signature ………………………. Date ……………………… Translator’s signature ………………………. Date ………………………. Lengolo la tumello Madume Mokgatatema O memelwa ho nka karolo dipatlisisong tsa ho fuputsa bo teng ba mafu a kelello batshwarueng ba ditjhankaneng. Dikarabo tsa hao di tla sebediswa ho fumana boleng ba mahloko a hlooho tjhankaneng ena. Ela hloko hore ho tlaba le moo dipotso tsa tokomane ena di tla o kgopisang teng. O dumelletswe ho emisa diphuputsong tsena kapa wa kgaotsa ho nka karolo ha o ultwa o ameha maikutlo haholo. O na le hona ho ka hana ho araba dipotso nakong ya dipatlisiso. Ho se nke karolo kapa hona ho kgaotsa ha hona sitisana le ditshwanelo tsa hao le thlokomelo ya hao eo e o loketseng mona tjhankaneng. Lesedi leo o refang lona le tla sebedisetswa dipatlisiso tsena feela, mme ditaba tse buueng etlaba tsa sephiri. Ke a leboha. Mokgetatema tekena mona……………… Letsatsi ke la………………… Mofuputsi tekena mona…………… Letsatsi ke la………………… Mohlalosi tekena mona………………. Letsatsi ke la………………… Ingelig toestemming Gedagte deelnemer, U word uitgenooi om aan ‘n studie oor die voorkoms van geestessiektes in korrektiewe dienste deel te neem. U antwoorde sal ons help om die omvang van geestessiekte by oortreders in hierdie sentrum te dokumenteer. Die onderhoud kan u met tye ontstel, en u het die reg om die onderhoud enige tyd te staak en van die studie te onttrek. U mag ook weier om sekere vrae te beantwoord indien u dit so verkies. U weiering of onttrekking van die studies sal geensins die kwaliteit van dienste waarop u geregtig in hierdie sentrum beïnvloed nie. U antwoorde sal slegs vir die doeleindes van hierdie studie gebruik word. Alle antwoorde sal konfidensieel handteer word. Deelnemer handtekening………………. Datum……………….. Navorser handtekening………………… Datum……………….. Vertaler handtekening…………………. Datum……………….. Information document: The prevalence of mental disorders among offenders admitted at health facilities in Bzzah Makhate Correctional Service Centre, Kroonstad, South-Africa. Dear participant I, Dr M.B Modupi, am conducting a study on the prevalence of mental illnesses among inmates admitted at Bizzah Makhate Correctional Service Facilities. The purpose of the research is to determine the prevalence of mental disorders among detained offenders, which go undiagnosed on admission to the correctional service facilities. I am inviting you to participate in this research study, which aims to answer the question stipulated above. If you agree to part take in the study, a questionnaire will be completed on your behalf by the researcher conducting the interview. The interview may last 20 to 30 minutes. The questionnaire includes questions which may be deemed sensitive or considered personal. The Health Science Research Ethics Committee of the University of the Free State may at any time inspect the research records and data analysis. Should the study be published this may lead to cohort identification. Contact details of researcher: 051 407 9911 Lengolo la boitsebiso Ho ata ha mahloko a kelello batshwaruweng ba kwalletsweng tjhankaneng ya Bizzah Makhate Correctional Service Centres, Kroonstad South-Africa. Madume Bakgatatema Nna ngaka M.B Modupi ke etsa difuputso tsa ho tseba ka mafu a kelello a teng batshwarueng ba tjhankaneng ena ya Bizzah Makhate mona Kroonstad. Lebaka la ho etsa diphuputso tsena ke ho lekanya mafu a kelello a teng batshwaruweng a sa tlohang a fupuditswe nakong eo batshwaruwa ba tshwarwang . Ke le memela ho nka karolo diphuuputsong tsena e le hore re fumane karabo ya dipatlisiso tsena. Ha o dumela ho nka karolo difuputsong tsena, lengolo la ho nka karolo le tla tlatswa ke mofuputsi. Dipotso ditla nka nako e kabang metsostso e mashome a mabedi ho ya mashome a mararo. Lengolong la dipotso ho tla ba teng dipotso tse tla o ama maikutlo ha bohloko. Tsohle tse tla buuwa e tla ba sephiri. Komiti ya Saense ya Diphuputso ya Yunivesithi ya Freistata e tla ba yona e tla thusang ka ho lekodisisa hantle diphuputso le lesedi le fumanweng. Ha diphuputso tsena di ka haswa, ho ka etsahala hore bakgatatema ba tsebahale. O ka fumana mofuputsi nomorong tsena: 051 407 9911 Inligtingsdokument Die voorkoms van geestesversteurings onder oortreders wat opgeneem word in gesondheidsentrums in Bizzah Makhate Korrektiewe Fasiliteite, Kroonstad, Suid-Afrika. Gedagte deelnemeer Ek, Dr M.B Modupi, doen ń studie oor die prevalensie van geestesversteurings onder oortreders wat opgeneem is by Bizzah Makhate Korrektiewe Fasiliteite. Die doel van die navorsing is om vas te stel wat die prevalensie van geestesversteurings in die populasie is wat ongediagnoseer is tydens opname. Ek nooi u om deel te neem in die studie om bogenoemde vraag te beantwoord. Indien u instem om deel te neem, sal ń vraelys namens u deur die navorser voltooi word tydens ń onderhoud. Die vraelys maag 20 tot 30 minute neem mom te voltooi. Persoonlike of sensitive vrae mag tydens die onderhoud gevra word. Personlike inligting sal so vêr moontlik vertoulik hanteer word. Die Gesondheidwetenskappe Navorsings-etiekkomitee van die Universiteit van die Vrystaat kan te enige tyd die navorsingsrekords en data-ontleding inspekteer. Indien die studie gepubliseer word, mag dit lei tot kohortidentifikasie. Kontak besonderhede van navorser: 051 407 9911 F. INFORMED CONSENT Informed consent Dear participant, You are hereby invited to take part in a study on the prevalence of mental disorders in correctional services. Your answers will help us document the extent of mental health disturbances among offenders in this centre. The interview may from time to time upset you, and you are free to stop and withdraw at anytime. You may also refuse to answer any question if you feel so. Your refusal or withdrawal from the study will not, in any manner, affect the quality of services you are entitled to in this establishment. Your responses will be used for the purpose of the study only. All responses will be kept confidential. Thank you Participant’s signature ………………………. Date ………………………. Researcher’s signature ………………………. Date ……………………… Translator’s signature ………………………. Date ………………………. Lengolo la tumello Madume Mokgatatema O memelwa ho nka karolo dipatlisisong tsa ho fuputsa bo teng ba mafu a kelello batshwarueng ba ditjhankaneng. Dikarabo tsa hao di tla sebediswa ho fumana boleng ba mahloko a hlooho tjhankaneng ena. Ela hloko hore ho tlaba le moo dipotso tsa tokomane ena di tla o kgopisang teng. O dumelletswe ho emisa diphuputsong tsena kapa wa kgaotsa ho nka karolo ha o ultwa o ameha maikutlo haholo. O na le hona ho ka hana ho araba dipotso nakong ya dipatlisiso. Ho se nke karolo kapa hona ho kgaotsa ha hona sitisana le ditshwanelo tsa hao le thlokomelo ya hao eo e o loketseng mona tjhankaneng. Lesedi leo o refang lona le tla sebedisetswa dipatlisiso tsena feela, mme ditaba tse buueng etlaba tsa sephiri. Ke a leboha. Mokgetatema tekena mona……………… Letsatsi ke la………………… Mofuputsi tekena mona…………… Letsatsi ke la………………… Mohlalosi tekena mona………………. Letsatsi ke la………………… Ingelig toestemming Gedagte deelnemer, U word uitgenooi om aan ‘n studie oor die voorkoms van geestessiektes in korrektiewe dienste deel te neem. U antwoorde sal ons help om die omvang van geestessiekte by oortreders in hierdie sentrum te dokumenteer. Die onderhoud kan u met tye ontstel, en u het die reg om die onderhoud enige tyd te staak en van die studie te onttrek. U mag ook weier om sekere vrae te beantwoord indien u dit so verkies. U weiering of onttrekking van die studies sal geensins die kwaliteit van dienste waarop u geregtig in hierdie sentrum beïnvloed nie. U antwoorde sal slegs vir die doeleindes van hierdie studie gebruik word. Alle antwoorde sal konfidensieel handteer word. Deelnemer handtekening………………. Datum……………….. Navorser handtekening………………… Datum……………….. Vertaler handtekening…………………. Datum……………….. G. QUESTIONNAIRE/PSYCHIATRIC INTERVIEW PSYCHIATRIC INTERVIEW Patient number FOR OFFICE USE 1. Age a) 18-25 1 b) 26-35 2 1 c) 36-50 3 d) 51-65 4 2. Gender a) male 1 2 b) female 2 3. Marital status a) single 1 b) married 2 3 c) divorced 3 d) widowed 4 e) unknown 5 4. Race a) black 1 b) Caucasian 2 4 c)coloured 3 d) asian 4 e) other 5 specify………………………………………… 5.Free State a) Fezile Dabi 1 District of b) Lejweleputswa 2 Origin c) Mangaung 3 5 d) Thabo Mofutsanyana 4 e) Xhariep 5 6. Highest level of a) None 1 education b) grade 1-8 2 c) grade 9-11 3 6 d) grade 12 4 e) graduate 5 f) postgraduate 6 g) other 7 specify…………………………………… 7. Employment a) unemployed and looking for a job 1 b) unemployed and not 7 looking for a job 2 c) formally employed 3 d) informally employed 4 e) self-employed 5 f) disability grant 6 g) pensioner 7 h) student 8 8. Income p/m a) less than R1000 1 b) between R1000-R5000 2 8 c) above R5000 3 d) unknown 4 9.Clinical Picture 9.1 Behaviour a) Echopraxia (pathological imitation of movements) 1 9 b) Catatonia 2 10 c) Negativism 3 11 d) Cataplexy (temporary loss of muscle tone) 4 12 e) Hyperactivity 5 13 f) Mimicry ( imitation motor activity of childhood) 6 14 g) Aggression 7 15 h) Stereotypy 8 16 i) Mannerism 9 17 j) Automatism (automatic performance of an act) 10 18 k) Mutism 11 19 l) Acting out 12 20 m) Abulia (reduced impulse to actor think) 13 21 n) Other (specify up to 1 month 14 22 9.2Consiousness a)Clear 1 b) Cloudy 2 c) Coma 3 d) Stupor 4 23 e)Delirium 5 9.3 Orientation 9.3.1 Person a) Orientated 1 b) Disorientated 2 24 9.3.2 Time a) Orientated 1 b) Disorientated 2 25 9.3.2Place a) Orientated 1 b) Disorientated 2 26 9.4 Attention a) Attentive 1 b) Distractible 2 c) Apathic (nonresponsive) 3 27 9.5Thought process and language 9.5.1 Form disturbance a) None 1 28 b) Neologism (new word created by a 2 29 patient) c) Word salad (incoherent mixture 3 30 words and phrases) d) Circumstantiality (indirect speech that is 4 31 delayed in reaching the point) e) Tangentiality (inability to have goal-directed 5 5 32 association of thoughts) f) Incoherence 6 33 g) Perseveration 7 34 h) Verbigeration (excessive, meaningless 8 35 and repetitive speech) i) Echolalia (repetition of words or phrases 9 36 of one person by another ) j) Irrelevant answers 10 37 k) Loosening of associations 11 38 l) Derailment 12 39 m) Flight of ideas 13 40 n) Blocking 14 41 o) Pressure of speech 15 42 p) Poverty of speech 16 43 q) Disturbed articulation 17 44 r) Other (specify) 18 45 9.5.2 Disturbance in content of thought a) Suicide ideation 1 46 b) Overvalued ideas 2 47 c) Homicide ideas 3 48 d) Obsessions 4 49 e) Compulsions 5 50 f)Paranoid delusions 6 51 (i) Delusions of persecuction 7 52 (ii) Delusions of grandeur 8 53 (iii) Delusions of reference 9 54 (iv)Delusions of self-accusation 10 55 (v) Delusions of control 11 56 g)Somatic delusions 12 57 h) Bizarre delusions 13 58 9.6 Memory 9.6.1 Short-term memory a) Good 1 b) Fair 2 59 c) Poor 3 9.6.2Recent memory a) Good 1 b) Fair 2 60 c) Poor 3 9.6.3Long-term memory a) Good 1 b) Fair 2 61 c) Poor 3 9.7 Perceptions 9.7.1 Auditory hallucination -yes 1 -no 2 62 9.7.2 Visual hallucination -yes 1 -no 2 63 9.7.3 Olfactory hallucination -yes 1 -no 2 64 9.7.4 Gustatory -yes 1 -no 2 65 9.7.5 Tactile hallucination -yes 1 -no 2 66 9.7.6Somatic hallucination -yes 1 -no 2 67 9.7.7 Hallucinosis -yes 1 -no 2 68 9.7.8 Illusions -yes 1 -no 2 69 9.7.9 Depersonalization -yes 1 -no 2 70 9.7.10 Derealization -yes 1 -no 2 7 1 9.8Affect a) Appropriate affect 1 b) Inappropriate affect 2 c) Restricted or constricted affect 3 d) Flat/Blunted affect 4 e) Combination 5 f) Other (specify) 6 72 9.9Mood a) Euthymic mood 1 73 b) Dysphoric mood 2 74 c) Expansive mood 3 75 d) Irritable mood 4 76 e) Mood swings 5 77 f) Elevated mood 6 78 g) Euphoria 7 79 h) Depressed mood 8 80 i) Anhedonia 9 81 j) Grief or mourning 10 82 k) Alexthymia 11 83 l) Anxiety 12 84 m) Agitation 13 85 n) Panic 14 86 o) Apathy (indifference, unresponsiveness) 15 87 p) Ambivalence 16 88 q) Abreaction (emotional discharge after recalling a painful experience) 17 89 r) Shame 18 90 s) Guilt 19 91 t)Other (specify) 20 92 9.10 Insight a) Good insight 1 b) Poor insight 2 93 9.11Judgment a) Good 1 b) Poor 2 94 9.12 Intelligence a) Above average 1 b) Average 2 c) Below average 3 d) Borderline intellectual functioning 4 95 9.13 Mode of Thinking a) Concrete thinking 1 b) Abstract thinking 2 96 9.14Hypothalamic Functioning 9.14.1Sleep patterns a) Normal sleep 1 b)Insomnia 2 97 c)Hypersomnia (excessive sleep) 3 9.14.2 Appetite a) Normal 1 b) Increase in appetite 2 c) Decrease in appetite 3 98 9.14.3Libido a) Normal 1 b) Increased 2 c) Diminished 3 99 9.14.4Autonomic Dysfunctions a) None 1 100 b) Constipation 2 101 c) Palpitations 3 102 d) Excessive sweating 4 103 e) Headaches 5 104 f) Fainting 6 105 g) Dizziness 7 106 h) Anxiousness 8 107 i) Other (specify) 9 108 10. Criminal behavior a) assault (AGBH) 1 109 b) rape 2 110 c) robbery 3 111 d) murder 4 112 e) hijacking 5 113 f) kidnapping 6 114 g) possession of illegal firearm 7 115 h) attempted murder 8 116 i) other 9 117 specify……………………… 11. Property crimes a) larceny 1 118 b) fraud 2 119 c) burglary 3 93 120 d) fencing 4 121 e) arson 5 122 f) malicious damage to property 6 123 12. Organizational a) white collar crime 1 Criminality b) organized crime 2 124 13. Public order a) drugs 1 125 Crimes b) alcohol 2 126 c) multiple drug use 3 127 d) illegal drug business 4 128 e) sex-related crimes (e.g prostitution, pornography 5 129 f) public violence 6 130 g) other 7 131 specify……………………………… 14. Public order a) Intellectual disabilities 1 132 Crimes b) Schizophrenia Spectrum 2 133 and other psychotic disorders c) Bipolar and related disorders 3 134 d) Depressive disorders 4 135 e) Neurocognitive disorder 5 136 f) Personality disorders 6 137 g) Sexual dysfunctions 7 138 h) Gender dysphorias 8 139 i) Paraphilic disorders 9 140 j) Substance related and 10 141 addictive disorders k) Anxiety disorders 11 1 142 l) No mental disorders 12 143 H. SUMMARY OF TURNITIN PLAGIARISM RESEARCH ENGINE I. Submission Guidelines: Psychiatry, Psychology and Law Psychiatry, Psychology and Law https://www.tandfonline.com/action/authorSubmission?show=instructions&journalC ode=tppl20 Instructions for authors Thank you for choosing to submit your paper to us. These instructions will ensure we have everything required so your paper can move through peer review, production and publication smoothly. Please take the time to read and follow them as closely as possible, as doing so will ensure your paper matches the journal’s requirements. For general guidance on every stage of the publication process, please visit our Author Services website. For editing support, including translation and language polishing, explore our Editing Services website This journal uses ScholarOne Manuscripts (previously Manuscript Central) to peer review manuscript submissions. Please read the guide for ScholarOne authors before making a submission. Complete guidelines for preparing and submitting your manuscript to this journal are provided below. Instructions for authors Thank you for choosing to submit your paper to us. These instructions will ensure we have everything required so your paper can move through peer review, production and publication smoothly. Please take the time to read them and follow the instructions as closely as possible. If you are not able to use the template via the links (or if you have any other template queries) please contact us here. Contents list About the journal Peer review Preparing your paper - Structure - Word count - Style guidelines - References - Checklist Using third-party material in your paper Declaration of interest Clinical Trials Registry Complying with ethics of experimentation - Consent - Health and safety Submitting your paper Data Sharing Policy Publication charges Copyright options Complying with funding agencies Open Access My Authored Works Article reprints About the journal Psychiatry, Psychology and Law is an international, peer-reviewed journal publishing high-quality, original research. Please see the journal’s Aims & Scope for information about its focus and peer-review policy. Please note that this journal only publishes manuscripts in English . Psychiatry, Psychology and Law accepts the following types of article: original articles and empirical studies; analyses of professional issues, controversies and developments in these areas; case studies and case commentaries; and book reviews. Peer review Taylor & Francis is committed to peer-review integrity and upholding the highest standards of review. Once your paper has been assessed for suitability by the editor, it will then be double blind peer-reviewed by independent, anonymous expert referees. Find out more about what to expect during peer review and read our guidance on publishing ethics . Preparing your paper All authors submitting to medicine, biomedicine, health sciences, allied and public health journals should conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Journals , prepared by the International Committee of Medical Journal Editors (ICMJE). Structure At submission, two documents are required: 1) Main document: Your paper should be compiled in the following order: title page; abstract; keywords; main text (introduction, materials and methods, results, discussion); acknowledgments; declaration of interest statement; references; appendices (as appropriate); table(s) with caption(s) (on individual pages); figures; figure captions (as a list). Please label this file ‘Main_document_with_full_author_details’. 2) Anonymised manuscript: Please also upload an anonymised manuscript with a title page and separate tables and figures. Word count Please include a word count for your paper. Papers should not usually exceed 12,000 words, including references, figure and table captions and notes. Style guidelines Manuscripts should be prepared depending on whether they are psychological or psychiatric in nature or legal, using the following: Title Page (p.1) should contain the article title, authors’ names and complete affiliations, footnotes to the title, and the address for manuscript correspondence (including e-mail, address and telephone and fax numbers), and a note, if applicable, of the conference at which the paper has been presented. Abstract (p.2) must be a single paragraph that summarizes the main findings of the paper in fewer than 150 words, including where appropriate the research methodology, findings and conclusions. After the abstract a list of up to 10 keywords that will be useful for indexing or searching should be included. Figures should be in a finished form suitable for publication and should be numbered consecutively with Arabic numbers in order of appearance in the text. Figures can be supplied as hard copy, but are preferred electronically in Adobe Illustrator, EPS or TIFF formats. They should be presented in black and white at a minimum print density of 600 dpi and should not include shaded areas of grey. Instead use repeated patterns of lines or crosses to distinguish, for example, different bars on a graph. Tables should be numbered consecutively with Arabic numbers in order of appearance in the text. Each table should by saved double-spaced on a separate page, with a short descriptive title typed directly above and with essential footnotes below. Psychological manuscripts should be prepared in accordance with the format and style specified in the ‘Publication Manual of the American Psychological Association’, fifth edition. Pages should be numbered consecutively. References should be cited in the text as specified in the Publication Manual of the American Psychological Association, fifth edition. A concise description of APA referencing style can be found here http://www.tandf.co.uk/journals/authors/style/layout/tf_1.pdf . Personal communications should be cited as such in the text and should not be included in the reference list. Psychiatric manuscripts should be prepared in accordance with the format and style specified in the ‘Uniform requirements for manuscripts submitted to biomedical Journals’ (which has been reproduced in the British Medical Journal 1982, 12 June; 284:1766– 1779; the Medical Journal of Australia 1982;2:590–6; and the Australian Alcohol/Drug Review 1985;4:5–13). Legal manuscripts should be prepared in accordance with the format and style specified in The Oxford Standard for Citation of Legal Authorities (OSCOLA). OSCOLA is designed to facilitate accurate citation of authorities, legislation, and other legal materials. Pages should be numbered consecutively and organized as follows: References should be cited in the text as specified in The Oxford Standard for Citation of Legal Authorities (OSCOLA). Titles of Journals should not be abbreviated. Cases should be cited in the usual English law form with the name of the case and its date in the text and a list of cases in alphabetical order at the end of the article. End notes should be short, if possible, and relate to the significance of a cited reference, rather than reflect an idea which could go into the text in parenthesis. Please use British spelling consistently throughout your manuscript. References Please use this reference guide when preparing your paper. References should be numbered consecutively in the order in which they are first mentioned in the text. References in the text, tables and legends to figures should be identified by Arabic numerals. References should be listed in numerical order at the end of the paper beginning on a new page. The Vancouver System of referencing should be used. For journal articles the names and then initials of all authors should be given, where there is six of fewer authors; commas should follow the last initials of each author but internal stops should be omitted. When there are seven or more authors list only the first three and then add et al. Following this should come the full title of the article, then the title of the journal abbreviated according to the style used in Index Medicus , the year of publication, volume number and first and last page number in that order. Psychology papers: For an overview of APA style (including referencing) visit http://www.lib.monash.edu.au/tutorials/citing/apa.html Psychiatry papers: For further information on 'Uniform requirements for manuscripts submitted to biomedical Journals' visit http://www.icmje.org/ Law papers: For a full description of the Journal's Oxford Law style (including referencing) visit http://denning.law.ox.ac.uk/published/oscola_2006.pdf Checklist: what to include 1. Author details . Please ensure everyone meeting the International Committee of Medical Journal Editors (ICJME) requirements for authorship is included as an author of your paper. All authors of a manuscript should include their full name and affiliation on the cover page. Where available, please also include ORCiDs and social media handles (Facebook, Twitter or LinkedIn). One author will need to be identified as the corresponding author, with their email address normally displayed in the article PDF (depending on the journal) and the online article. Authors’ affiliations are the affiliations where the research was conducted. If any of the named co- authors moves affiliation during the peer-review process, the new affiliation can be given as a footnote. Please note that no changes to affiliation can be made after your paper is accepted. Read more on authorship . 2. A non-structured abstract of 150 words. Read tips on writing your abstract . 3. Graphical abstract . This is an image to give readers a clear idea of the content of your article. It should be a maximum width of 525 pixels. If your image is narrower than 525 pixels, please place it on a white background 525 pixels wide to ensure the dimensions are maintained. Save the graphical abstract as a .jpg, .png, or .gif. Please do not embed it in the manuscript file but save it as a separate file, labelled GraphicalAbstract1. 4. You can opt to include a video abstract with your article. Find out how these can help your work reach a wider audience, and what to think about when filming . 5. 10 keywords . Read making your article more discoverable , including information on choosing a title and search engine optimisation. 6. Funding details . Please supply all details required by your funding and grant- awarding bodies as follows: For single agency grants This work was supported by the under Grant . For multiple agency grants This work was supported by the under Grant ; under Grant ; and under Grant . 7. Disclosure statement . This is to acknowledge any financial interest or benefit that has arisen from the direct applications of your research. Further guidance on what is a conflict of interest and how to disclose it . 8. Biographical note. Please supply a short biographical note for each author. This could be adapted from your departmental website or academic networking profile and should be relatively brief (e.g. no more than 100 words). 9. Data availability statement. If there is a data set associated with the paper, please provide information about where the data supporting the results or analyses presented in the paper can be found. Where applicable, this should include the hyperlink, DOI or other persistent identifier associated with the data set(s). Templates are also available to support authors. Data deposition. If you choose to share or make the data underlying the study open, please deposit your data in a recognized data repository prior to or at the time of submission. You will be asked to provide the DOI, pre-reserved DOI, or other persistent identifier for the data set. Geolocation information. Submitting a geolocation information section, as a separate paragraph before your acknowledgements, means we can index your paper’s study area accurately in JournalMap’s geographic literature database and make your article more discoverable to others. More information . 10. Supplemental online material. Supplemental material can be a video, dataset, fileset, sound file or anything which supports (and is pertinent to) your paper. We publish supplemental material online via Figshare. Find out more about supplemental material and how to submit it with your article . 11. Figures. Figures should be high quality (1200 dpi for line art, 600 dpi for grayscale and 300 dpi for colour). Figures should be saved as TIFF, PostScript or EPS files. 12. Tables. Tables should present new information rather than duplicating what is in the text. Readers should be able to interpret the table without reference to the text. Please supply editable files. 13. Equations . If you are submitting your manuscript as a Word document, please ensure that equations are editable. More information about mathematical symbols and equations . 14. Units. Please use SI units (non-italicized). Using third-party material in your paper If you wish to include any material in your paper for which you do not hold copyright, you will need to obtain written permission from the copyright owner prior to submission. More information on requesting permission to reproduce work(s) under copyright . Declaration of interest Please include a declaration of interest statement, using the subheading “Declaration of interest.” If you have no interests to declare, please state this (suggested wording: The authors report no conflict of interest). For all NIH/Wellcome-funded papers, the grant number(s) must be included in the declaration of interest statement. Read more on declaring conflicts of interest . Clinical Trials Registry In order to be published in a Taylor & Francis journal, all clinical trials must have been registered in a public repository at the beginning of the research process (prior to patient enrolment). Trial registration numbers should be included in the abstract, with full details in the methods section. The registry should be publicly accessible (at no charge), open to all prospective registrants, and managed by a not-for-profit organization. For a list of registries that meet these requirements, please visit the WHO International Clinical Trials Registry Platform (ICTRP). The registration of all clinical trials facilitates the sharing of information among clinicians, researchers, and patients, enhances public confidence in research, and is in accordance with the ICMJE guidelines . Complying with ethics of experimentation Please ensure that all research reported in submitted papers has been conducted in an ethical and responsible manner, and is in full compliance with all relevant codes of experimentation and legislation. All papers which report in vivo experiments or clinical trials on humans or animals must include a written statement in the Methods section. This should explain that all work was conducted with the formal approval of the local human subject or animal care committees (institutional and national), and that clinical trials have been registered as legislation requires. Authors who do not have formal ethics review committees should include a statement that their study follows the principles of the Declaration of Helsinki . Please ensure the correct ethical statement is added to your manuscript before submission: Two general suggestions are included below, where the appropriate institutional and / national committees need to be identified in suggestion 1 and all authors must be identified in the declaration of conflicts of interest in both suggestions: 1. For articles where studies with human participants were involved: Ethical standards Declaration of conflicts of interest Author A [add name of author here] has declared no conflicts of interest Author B [add name of author here] has declared no conflicts of interest Author C [add name of author here] has declared no conflicts of interest Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (add as appropriate) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent Informed consent was obtained from all individual participants included in the study 2. For articles that do not contain information on any studies with human/animal participants: Ethical standards Declaration of conflicts of interest Author A [add name of author here] has declared no conflicts of interest Author B [add name of author here] has declared no conflicts of interest Author C [add name of author here] has declared no conflicts of interest Ethical approval This article does not contain any studies with human participants or animals performed by any of the authors. Consent All authors are required to follow the ICMJE requirements on privacy and informed consent from patients and study participants. Please confirm that any patient, service user, or participant (or that person’s parent or legal guardian) in any research, experiment, or clinical trial described in your paper has given written consent to the inclusion of material pertaining to themselves, that they acknowledge that they cannot be identified via the paper; and that you have fully anonymised them. Where someone is deceased, please ensure you have written consent from the family or estate. Authors may use this Patient Consent Form , which should be completed, saved, and sent to the journal if requested. Health and safety Please confirm that all mandatory laboratory health and safety procedures have been complied with in the course of conducting any experimental work reported in your paper. Please ensure your paper contains all appropriate warnings on any hazards that may be involved in carrying out the experiments or procedures you have described, or that may be involved in instructions, materials, or formulae. Please include all relevant safety precautions; and cite any accepted standard or code of practice. Authors working in animal science may find it useful to consult the International Association of Veterinary Editors’ Consensus Author Guidelines on Animal Ethics and Welfare and Guidelines for the Treatment of Animals in Behavioural Research and Teaching . When a product has not yet been approved by an appropriate regulatory body for the use described in your paper, please specify this, or that the product is still investigational. Submitting your paper This journal uses ScholarOne Manuscripts to manage the peer-review process. If you haven't submitted a paper to this journal before, you will need to create an account in ScholarOne. Please read the guidelines below and then submit your paper in the relevant Author Centre, where you will find user guides and a helpdesk. Data Sharing Policy This journal applies the Taylor & Francis Basic Data Sharing Policy. Authors are encouraged to share or make open the data supporting the results or analyses presented in their paper where this does not violate the protection of human subjects or other valid privacy or security concerns. Authors are encouraged to deposit the dataset(s) in a recognized data repository that can mint a persistent digital identifier, preferably a digital object identifier (DOI) and recognizes a long-term preservation plan. If you are uncertain about where to deposit your data, please see this information regarding repositories. Authors are further encouraged to cite any data sets referenced in the article and provide a Data Availability Statement. At the point of submission, you will be asked if there is a data set associated with the paper. If you reply yes, you will be asked to provide the DOI, pre-registered DOI, hyperlink, or other persistent identifier associated with the data set(s). If you have selected to provide a pre-registered DOI, please be prepared to share the reviewer URL associated with your data deposit, upon request by reviewers. Where one or multiple data sets are associated with a manuscript, these are not formally peer reviewed as a part of the journal submission process. It is the author’s responsibility to ensure the soundness of data. Any errors in the data rest solely with the producers of the data set(s). Publication charges There are no submission fees, publication fees or page charges for this journal. Colour figures will be reproduced in colour in your online article free of charge. If it is necessary for the figures to be reproduced in colour in the print version, a charge will apply. Copyright options Copyright allows you to protect your original material, and stop others from using your work without your permission. Taylor & Francis offers a number of different license options. Read more on publishing agreements . Complying with funding agencies We will deposit all National Institutes of Health or Wellcome Trust-funded papers into PubMedCentral on behalf of authors, meeting the requirements of their respective open access (OA) policies. If this applies to you, please tell our production team when you receive your article proofs, so we can do this for you. Check funders’ OA policy mandates here . Find out more about sharing your work . Open access This journal is compliant with the Research Councils UK OA policy, and gives authors the option to publish open access via our Open Select publishing program , making it free to access online immediately on publication. Taylor & Francis Open Select gives you, your institution or funder the option of paying an article publishing charge (APC) to make an article open access. Please contact openaccess@tandf.co.uk if you would like to find out more, or go to our Author Services website . For more information on license options, embargo periods and APCs for this journal please go here . You can also check our page on open access funder policy and mandates . My Authored Works On publication, you will be able to view, download and check your article’s metrics (downloads, citations and Altmetric data) via My Authored Works on Taylor & Francis Online. This is where you can access every article you have published with us, as well as your free eprints link , so you can quickly and easily share your work with friends and colleagues. We are committed to promoting and increasing the visibility of your article. Here are some tips and ideas on how you can work with us to promote your research . Article reprints For enquiries about reprints, please contact the Taylor & Francis Author Services team at reprints@tandf.co.uk . To order a copy of the issue containing your article, please contact our Customer Services team at OrderSupport@TandF.co.uk . Updated 23-5-2018