An investigation into the routes to inpatient care at the Pantang Hospital in Ghana via the criminal justice system

OBJECTIVES: To develop knowledge of routes by which patients are admitted to Pantang hospital via the courts or police and to explore the factors that prevent discharge, rehabilitation or transfer to prison of these patients. SETTING: Pantang Psychiatric Hospital, Accra, Ghana, West Africa DESIGN: A cross-sectional exploratory qualitative study. PARTICIPANTS: Adult patients with a psychiatric diagnosis who had been admitted to hospital following involvement with the criminal justice system and their families; and stakeholders (participants who had experience working with mentally disordered offenders). METHODS: A descriptive and ethnographic survey of patients plus interviews with key stakeholders in mental health and criminal justice. Data were analysed using hybrid thematic analysis. RESULTS: Patients arrived at Pantang Psychiatric Hospital following referral by the arresting police authorities, through court referral, or directly from prisons. All participants reported lack of understanding of the mental health and criminal justice systems, and interface between the two. Most patients and family members reported they feared the stigma of mental illness and patients' criminal charges would interrupt the patients' successful reintegration into the community. CONCLUSION: This study revealed that forensic mental health patients in the Pantang Hospital entered through one of three ways; direct entry through the community-based policing system; on order through the court system; and referrals directly from the prison system. Inadequate staffing and other resources resulted in delays in completing the necessary psychiatric assessments. FUNDING: The study was funded locally and by a grant received from the Faculty of Forensic Psychiatry, Royal College of Psychiatrists in the UK.