More than 100 mentally ill patients in the Eastern Cape are being held in prisons despite being declared unfit to stand trial, as a shortage of beds in psychiatric wards leaves them in legal and medical limbo.
Nationally, 3,415 state patients are admitted to psychiatric facilities, with Komani Hospital and the Fort England Hospital in Makhanda accounting for a combined 729 — the highest in the country.
State patients are individuals who have committed serious offences but are declared by a court to be unfit to stand trial or not criminally responsible due to mental illness or intellectual disability.
They are meant to be referred to specialised psychiatric institutions for care, treatment and observation.
However, limited capacity has resulted in hundreds of these patients remaining in correctional facilities for extended periods, effectively leaving them in a system not designed to meet their medical or psychological needs.
Between April 2025 and the end of February 2026, the number of these patients admitted in the Eastern Cape increased by 76, placing additional strain on facilities already operating at capacity.
National department of health director for mental health and substance abuse Dudu Shiba said the growing backlog was stretching both infrastructure and personnel, limiting the ability of hospitals to admit new patients.
The backlog has also strained relations between the health and justice departments, with an outstanding R380m bill for forensic mental observations further complicating the situation.
Shiba said the justice department had not paid for these services since 2023, forcing the health department to absorb the costs.
“The [department of health] continues to use its resources for this service that is not funded,” she said.
The issue came under scrutiny during a presentation to the portfolio committee on correctional services in parliament on Tuesday.
The presentation revealed that 437 state patients eligible for admission remained in prison cells across the country, including 120 in the Eastern Cape.
There are 14 facilities nationwide designated to admit state patients, with at least one such facility in each province except Mpumalanga.
Shiba said limited space at psychiatric hospitals was largely due to infrastructure challenges, with some facilities in urgent need of repair and expansion.
She singled out facilities in Komani, Gqeberha and Makhanda as urgently requiring infrastructure upgrades and revitalisation projects.
In addition to infrastructure constraints, Shiba pointed to systemic challenges within the justice system that contributed to overcrowding.
“There is also a delay by the courts to grant discharges or reclassifications of state patients.”
She said courts sometimes declared individuals accused of relatively minor offences as state patients, which placed additional pressure on limited hospital capacity.
Substance abuse was identified as a major contributing factor in many cases requiring forensic mental assessment.
Acting health director-general Prof Nicholas Crisp told MPs that provincial health systems were already under pressure due to budget constraints, making it difficult to expand services.
“I don’t think the public and some of the members of parliament know just how difficult it is to run a department where the provinces run the services,” he said.
“It’s not the national department of health that runs these services.
“Provinces receive their budgets through the equitable share, and each has its own challenges and priorities.”
Crisp said this often resulted in uneven service delivery, with some provinces better resourced than others, further complicating efforts to address national backlogs.
Correctional services chief deputy commissioner Anna Molepo said the department was working with health authorities to manage state patients being held in prisons.
“We are working very closely with the department of health,” she said.
Molepo said a virtual training session on mental healthcare policy and procedures was conducted in November for correctional centre heads and healthcare professionals.
She added that a memorandum of understanding had been signed with Johnson & Johnson to provide further training to healthcare staff.
“If there are any psychosocial support needs, we refer patients to social workers and psychologists.
“We also provide treatment in line with primary healthcare guidelines,” she said.
Despite these interventions, Molepo acknowledged the financial burden of housing state patients in correctional facilities, estimating the cost at about R8m a month.
Human rights advocates have criticised this situation, arguing that it reflects a long-standing failure to adequately separate medical care from incarceration.
It is about time that the president establishes a commission of inquiry to investigate these issues and others affecting the department
— Golden Miles Bhudu, South African Prisoners Organisation for Human Rights founder
South African Prisoners Organisation for Human Rights founder Golden Miles Bhudu said correctional services had strayed from its mandate.
“These institutions are incarcerating people who are not of stable mind in facilities that are not designed to care for them,” he said.
“It is about time that the president establishes a commission of inquiry to investigate these issues and others affecting the department.”
Bhudu said the continued detention of mentally ill individuals in prisons undermined constitutional principles and raised serious concerns about dignity and access to appropriate care.
Shiba also highlighted a shortage of mental health specialists, particularly in rural areas such as Komani, Umzimkhulu and Hayani.
She said SA had about 942 psychiatrists, with about 75% working in the private sector while most patients relied on public health care.
“The equitable sharing of resources between the private and public sector, as envisaged under universal health coverage, is central to addressing this problem,” she said.
In the interim, the department has begun implementing short-term interventions to ease pressure on facilities, including recruiting specialists and strengthening multidisciplinary teams.
A psychiatrist was appointed at Komani Hospital in 2025 through a targeted recruitment process.
However, concerns remain about conditions in psychiatric facilities and the broader system’s ability to protect vulnerable patients.
Daily Dispatch
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