Hundreds of South Africans living with severe mental illnesses are being held in prison cells, not because they’ve been convicted of crimes, but because the country’s psychiatric hospitals have run out of space. These individuals—known as state patients—have been declared unfit to stand trial or criminally liable due to mental illness, and by law, they should be receiving treatment in specialised health facilities. Instead, many are languishing in correctional facilities unequipped to meet their complex mental health needs.
The latest figures confirm the scale of the problem: as of May 2025, the Department of Correctional Services (DCS) reports at least 331 state patients are being held in prisons, while the Department of Health estimates the number to be closer to 400. This marks a dramatic increase from around 200 last year, and it is the highest number recorded since data began in 2019.
By law, state patients should be moved to psychiatric hospitals within 14 to 30 days of being declared unfit by the court. However, South Africa’s 13 designated psychiatric hospitals only offer around 1,937 beds, while the number of state patients nationwide has surged to 3,765. That leaves a shortfall of nearly 1,500 beds, forcing the correctional system to step in as a stopgap.
Correctional Services Minister Pieter Groenewald, speaking in Parliament earlier this month, revealed that he had sent multiple requests to the Minister of Health, urging the department to accept more state patients into mental health facilities. “If the minister responds tomorrow and says, ‘send them’, we will send them almost that same day,” Groenewald said. “But we can’t just offload patients— hundreds who are currently in our care—without proper coordination and medical readiness.”
This legal contradiction has created a gray area where departments pass the responsibility back and forth, and patients fall through the cracks. Health Department spokesperson Foster Mohale acknowledged the delay, admitting that although transfers should ideally happen within 30 days, administrative and infrastructural challenges make this unrealistic in many cases—leaving hundreds of mentally ill individuals stuck in prisons instead of receiving proper psychiatric care.
The Department of Correctional Services is clear: prisons are not hospitals. In its annual report, the DCS emphasises that the goal of managing state patients is treatment and rehabilitation—not punishment. Yet, many of these patients are locked up in overcrowded prisons without access to adequate psychiatric care.
According to the Judicial Inspectorate for Correctional Services (JICS), while some state patients are held in prison for only a few weeks, many remain incarcerated for several months or even years. Shockingly, at least three individuals have been held in prison for over four years without being transferred to proper medical facilities.
This prolonged detention has serious consequences for both the patients and the prison system. Correctional officers are not trained to handle complex mental illnesses, and untreated patients often deteriorate, becoming a danger to themselves and others.
The Health Department attributes much of the backlog to aging infrastructure and a chronic shortage of mental health professionals. Some psychiatric hospitals—caring for hundreds of state patients—are over 100 years old and in urgent need of upgrades. Plans are underway to build a new psychiatric facility in Mpumalanga, and infrastructure improvements are ongoing at existing sites.
Another pressing challenge is the shortage of psychiatrists, particularly in rural provinces such as the Eastern Cape. Mohale noted that two new psychiatrists have recently been recruited through international hiring, and the department is exploring partnerships with universities to attract more professionals.
In response to the crisis, the Health Department is also considering partnerships with non-profit organisations to provide care for the hundreds of patients who no longer require hospitalisation but are not yet ready to return to their communities. The department is also looking into assigning state patients to custodians earlier in the process to support their eventual reintegration.
South Africa’s correctional facilities have become the holding cells of last resort for the mentally ill—not by design, but by default. The country’s lack of psychiatric beds, legal ambiguities, and under-resourced healthcare system have converged to create a crisis where prisons serve as substitutes for proper treatment centres. Already, hundreds of state patients are confined in these facilities, and unless immediate and coordinated action is taken between government departments, hundreds more will be trapped in a system that punishes where it should heal.
Source- EWN
