FORENSIC PSYCHIATRIC REHABILITATION IN DEVELOPED COUNTRIES

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CHAPTER 3 RESEARCH DESIGN AND METHODS

“The opening of public discourse to multiple voices and perspectives calls into question the very notion of a single standpoint from which a final overriding version of the world can be written.”
Smith (1989)

INTRODUCTION

This chapter describes the research methodology that was used to develop a medico-judicial framework for the rehabilitation of forensic psychiatric patients in special institutions in Zimbabwe. This setting was chosen because it was the only provider of forensic psychiatric services in Zimbabwe. The design is discussed followed by a discussion of the methods used to conduct this study.

RESEARCH DESIGN

A research design is a general plan about how a researcher will answer the research question (Saunders et al 2009:136). These authors note that the design contains clear objectives, exacting how the researcher collected data and addressed ethical issues. Polit and Beck (2012:487) suggest that the research question should drive the inquiry together with its designs and methods. The research question, “What should a medico-judicial framework consist of for the rehabilitation of forensic psychiatric patients in Zimbabwe?” directed this study. The discussion on the design begins with comments on the choice of a partially mixed sequential dominant status design after which the grounded theory approach is discussed.

Mixed sequential dominant status design

The sequential design is the most commonly used mixed research design in under-researched areas (Srnka & Koeszegi 2007:33). According to Srnka and Koeszegi (2007:33), using this design for the preliminary stages of the qualitative approach makes it possible for the researcher to develop instruments of measurement for the quantitative study.
Figure 3.1 presents a layout of the partially mixed sequential dominant status design (QUAL/quant) that was used in the current study to develop the medico-judicial framework for the rehabilitation of forensic psychiatric patients in Zimbabwe.
The qualitative phase (QUAL) preceded the quantitative phase (quant) (Wao & Onwuegbuzie 2011:118). Priority or weight was given to the qualitative approach because the researcher’s primary interest was to gain an in-depth understanding of the experiences of the judicial team, multidisciplinary health (medical) team, relatives of forensic psychiatric patients and the stable male forensic psychiatric patients regarding the rehabilitation of forensic psychiatric patients in special institutions in Zimbabwe (Creswell & Plano-Clark 2011:71). The qualitative aspect was viewed as a mapping exercise that was meant to inform the overall design and quantitative part of the study (Johnson & Christensen 2008:51).
The researcher followed the counsel of Srnka and Koeszegi (2007:35) who mapped a way for sequencing the qualitative and quantitative data. In the first stage, the researcher sourced material by collecting qualitative data through semi-structured interviews from the judicial team, multidisciplinary health team, the stable male forensic psychiatric patients and the relatives of general forensic psychiatric patients. The researcher proceeded to the second stage where she obtained transcription material by copying the data into written form following the rules of transcription. The third was a stage of unitisation where material was divided into units of coding and analysis. After following the rules of unitisation, units that could be codified started to emerge. In the following stage, categorisation was made where preliminary coding was developed inductively to come up with a category scheme. Final coding was done where codes were assigned to units. This exercise resulted in availing nominal data. The final output was clear categories that were used to formulate questions in the quantitative phase of the study.
The compatibility of the qualitative and quantitative methods is a major tenet of the mixed methods approach. The idea is that both numerical and text data, collected sequentially, should assist the researcher to understand the research problem (Creswell & Plano Clark 2011:2) Three issues were considered in designing this study. These included priority, implementation and integration (Tritter cited in Saks & Allsop 2007:303). Priority was meant to address which method was to be given more emphasis between qualitative and quantitative approaches in the study. Implementation specified the sequence of data collection and analysis in the study while integration highlighted the phase in the research process where cohesion or connection of the qualitative or quantitative data would occur. These three principles are operationalised in Chapters 4, 5 and 6.
Triangulation was meant to enhance the credibility of the study findings. It also sought complementarities in which case results from the qualitative aspect of the research were clarified and illustrated by applying the qualitative findings during the development of the quantitative document review instrument and data collection and analyses processes (Johnson, Onwuegbuzie & Turner 2007:115; Patton 2002:22). Qualitative and quantitative data were collected and analysed in sequential order. This made it possible for the research questions for the quantitative phase of the study to evolve from the inferences of the qualitative phase which was basically exploratory. The quantitative phase then became confirmatory (Cameron 2009:145). This notion is supported by Brannen (2005:22) who confirms that qualitative methods that come before quantitative methods can be used to develop coded questions that can be used in a survey.
The disadvantage of the partially mixed sequential dominant status design is that the researcher in this study had to be competent in using both qualitative and quantitative designs of which the researcher was. There was also a need for resources that underlined extensive data collection processes in this method (Cameron 2009:145).

Grounded theory approach

Martin and Turner’s (1986:141) description of grounded theory as a methodology that allows researchers to discover phenomena that they can link directly to the data that they would have gathered in the field is supported by Jones and Alony (2011:1). In other words, data are collected and analysed after which a theory is developed that is ‘grounded’ in the data (Johnson & Christensen 2008:411; Strauss & Corbin 1994:46). It is, however, important to note that the grounded theory approach embraced by this study was the Charmaz persuasion built on a pragmatist underpinning with a social constructivist orientation. As such, whilst simultaneous data collection and analysis was observed, the emphasis was on the phenomenon of interest (the rehabilitation of forensic psychiatric patients) rather than on the methods used to study it.
Debates regarding research have been raging to the effect that mixed methods can be positioned in pragmatism. This notion therefore fits the grounded theory approach in investigating the realities of forensic psychiatry rehabilitation in special institutions in Zimbabwe (Feilzer 2010:6; Morgan 2007:48). The researcher chose the grounded theory approach because her study was an exploratory qualitative dominant mixed method research study. This translated to the notion that it was appropriate to weave it to the grounded theory approach because of its constructivist orientation which is considered to be appropriate for a qualitative epistemology (Johnson et al 2010:68). The researcher also aimed to have a detailed, rigorous insight into the rehabilitation of forensic psychiatric patients in special institutions in Zimbabwe. She therefore envisaged that the explained combinations would assist her to gestalt the findings and results of the study to obtain a comprehensive picture.
An example that used a mixed method with a grounded theory approach orientation is a study that was conducted by the MIRA Team composed of Sahin-Hodoglugil, van der Straten, Cheng, Montgomery, Kacanek, Mtetwa, Morar, Munyoro and Padian in 2009. The team did a randomised controlled clinical trial of a mixed method orientation to study the effect of diaphragm as a low cost HIV prevention method. These researchers invoked an iterative process whereby the quantitative and qualitative methods informed each other. The idea was to empower women on having control on HIV being transmitted to them. During the qualitative phase of the study, the complexity of the method implementation was revealed when it became apparent that the women concerned could not operate covertly without disclosing to their partners. In a similar manner, the current study initially used a constructivist grounded theory (qualitative) approach in which the narrated experiences of the judicial, medical, patients and relatives regarding the rehabilitation of forensic psychiatric patients were subjected to inductive and comparative analyses during the constructing reality process. The findings of the approach were ‘disputed’ by the quantitative results; especially by the medical participants. This is based on the fact that there was little evidence documented to confirm services that the medical team claimed to have been giving to forensic psychiatric patients in the patients’ files. This deep and broad reality of forensic psychiatric rehabilitation would not have been illuminated if the qualitative inquiry had not been corroborated by the quantitative part of the study which elicited a more nuanced analysis of this phenomenon of forensic psychiatric rehabilitation (Johnson et al 2007:123).
Key issues related to the rehabilitation of forensic psychiatric patients evolved from the opinions and experiences expressed by participants (Millis, Bonner & Francis 2006:2). A multiplicity of truths from the judicial team, medical team, male mentally stable forensic psychiatric patients and relatives of forensic patients made it possible for the researcher to analyse the data and develop a framework that was reflective of the situation and experiences at special institutions. Grounded theory was also appropriate in this study because it insists that interpretations must include the “perspectives and voices of the people who were studied” (Millis et al 2006:4).
Bowen (2005:217) supports the current researcher’s beliefs that the ontology and epistemology of the constructivist grounded theory research knowledge is fluid because it keeps on evolving. The transformation of this knowledge can only be interpreted by the participant and the researcher. In this study, grounded theory offered the researcher the capacity to interpret the issues and constructed experiences of the participants. It enabled her to put together and sort evolving concepts into patterns and saturations right through to abstraction (Jones & Alony 2011:97). Systematic data collection and analysis illuminated the rehabilitation of forensic psychiatric patients. The insight then assisted in developing a medico-judicial framework for the rehabilitation of forensic psychiatric patients in Zimbabwe.

Qualitative phase

This first phase of the study was primarily based on a qualitative, constructivist and interpretive view of the research process while at the same time appreciating the benefit of the quantitative approach to the research (Johnson et al 2007:124; De Lisle 2011:93). Patton (2002:39) defines qualitative research as that which concludes its findings from real world situations where phenomena of interest occur naturally instead of using statistical parameters. In this study the qualitative phase was immersed in the participants’ lived experiences. The researcher endeavoured to make sense of the participants’ views, experiences and beliefs (Shank 2002:25). Advantages for using this approach were that it illuminated forensic psychiatry rehabilitation practice that has been dismissed by mainstream research in Zimbabwe. The reason for using the qualitative phase was that it allowed the researcher to follow and explore unexpected routes of ideas that emerged from the study. The researcher let the data speak as she discovered and reconciled the meaning of the rehabilitation of forensic psychiatric patients that has not been understood before in Zimbabwe (Shank 2002:11).
The qualitative phase assisted the researcher to describe in detail the rehabilitation of forensic psychiatric patients as it is situated and embedded in special institutions. The approach gave the researcher an awareness of the emic or insider’s point of view as she described personal experiences of the judicial, medical, the forensic psychiatric patients and the relatives of forensic psychiatric patients (Johnson & Onwuegbuzie 2004:19). Having a more insightful understanding of the participants’ personal experiences enabled the researcher to develop the medico-judicial framework from the perspective of the these participant stakeholders rather than trying to develop it from those that lived outside the experience of the rehabilitation processes in special institutions (Ospina 2004:9). It was possible because the qualitative phase allowed the researcher to understand how the participants interpreted constructs. In addition, the study itself was responsive to the situation and conditions in special institutions where the needs of the judicial, medical and forensic psychiatric patients are (Johnson & Onwuegbuzie 2004:19).
A qualitative approach was also considered relevant for the analysis of the concepts and themes derived from the exploration of the medico-judicial procedures related to the rehabilitation process followed during the detention of forensic psychiatric patients. With this approach the concepts that explored the stakeholders’ recommendations for the development of the medico-judicial framework could be analysed. The weakness of a qualitative approach is that results cannot be generalised beyond the population with which the study was done. It is also believed that researcher idiosyncrasies and bias may influence the research outcomes (Johnson & Onwuegbuzie 2004:19). These weaknesses were addressed by triangulation of paradigms (Creswell & Plano Clark 2011:211).

Quantitative phase

In the current study a quantitative instrument construction followed the qualitative phase. This was in the form of a data sheet for a survey. The instrument was meant to collect information from documents of forensic psychiatric patients admitted in special institutions from 2005 to 2010. In this grounded theory research study these documents were considered as extant texts and the researcher was not involved in their construction (Charmaz 2014:45). These extant documents were purported to assist in answering the research question. This smaller quantitative component came second in sequence because it was not the priority approach to answering the research question; the quantitative data were used to enhance and complement the qualitative findings (Brannen 2005:22). This part of the study gave a documented complementary picture of current trends and realities in the rehabilitation of forensic psychiatric patients. The document review also identified the rehabilitative mental health services available to forensic psychiatric patients in two special institutions in Zimbabwe. As indicated above the quantitative phase was based on a limited variable. As such it was considered as complementary data to the narrative data (themes) in the qualitative part of the study (Wao & Onwuegbuzie 2011:118).
The qualitative findings and quantitative results were then integrated and interpreted collectively. Bryman (2008:7) points out that “the key issue is whether in a mixed project the end product is more than the sum of individual quantitative and qualitative part”. The point of employing this strategy was to use quantitative data and results to complement the interpretation of the qualitative findings. The primary focus was threefold: to explore and describe the stakeholders’ experiences of the medico-judicial procedures related to rehabilitation followed during the detention of forensic psychiatric patients in Zimbabwe. Secondly, it was to explore and describe stakeholders’ recommendations for the development of a medico-judicial framework. Finally, to develop an instrument to review the documents of forensic psychiatric patients admitted in special institutions from 2005 to 2010 in order to identify the rehabilitative mental health services available to forensic psychiatric patients in two special institutions in Zimbabwe.
This approach was advantageous because the researcher was able to explore the rehabilitation of forensic psychiatric patients in special institutions and it was possible to expand on the qualitative findings. The approach was appropriate in building the medico-judicial framework for the rehabilitation of forensic psychiatric patients in special institutions in Zimbabwe. The largely qualitative study was made more believable to the quantitative oriented audience owing to the approach under discussion. The overall limitation of this partially mixed sequential dominant status design was that using two approaches required a long time to complete both data collection phases.

POPULATION AND SAMPLING

According to Johnson and Christensen (2008:223), a population is a typical element or individual. Polit and Beck (2012:273) further breaks down the concept ‘population’ to say the target population is the aggregate of cases about which the researcher would like to make generalisations. The accessible population is that part of the target population that is accessible to the researcher (Grove et al 2012:351).
The population for this study included the judicial team and the multidisciplinary health (medical) team. The members of the judicial team consisted of a senior public prosecutor, a member of the Mental Health Review Tribunal, magistrates, public prosecutors, a regional clerk of the court and an officer in charge of the prison directly related to the commission of forensic psychiatric patients to special institutions. All members of the judicial team were 9 (nine) in total. The medical team comprised of psychiatrists, psychiatric nurses, and medical social workers. These were 11 (eleven) in total. The male mentally stable patients admitted in special institutions were also included in the study. Males were chosen because they formed the bulk of forensic psychiatric patients and are cared for separately from criminal offenders. There were four (4) male mentally stable patients in total. Relatives of forensic psychiatric patients were also theoretically sampled into the study and were 5 (five) in total.
Validation of the medico-judicial framework added experts to this pool of participants. To clarify further, there were three levels of participation from the medical and judicial teams. Firstly there were participants from the judicial and medical teams who participated only in Phase 1 of the study where the objective was: ‘To explore and describe the stakeholders’ experiences of the medico-judicial procedures related to rehabilitation followed during the detention of forensic psychiatric patients in Zimbabwe’ was addressed.
Secondly, there were judicial and medical participants that participated in both Phase 1 and also during the validation exercise in Phase 3.The objective addressed by Phase 3 was: ‘To validate the medico-judicial framework by a group of experts and stakeholders’. The participants are specified in Section 3.9.1 of this chapter.
Thirdly there were those participants that took part only as experts during the validation exercise in Phase 3. The experts included the lecturer at the University of Zimbabwe, the Chief Occupational Therapist and the Principal Nursing Officer of the civil psychiatric hospital which is a national referral hospital for psychiatric disorders in Zimbabwe; thus three (3) participants in total. This aforementioned population was specific to the qualitative phase of the research study. The target population for the quantitative phase of the study included 598 records of patients committed to the special institutions between 2005 and 2010. Of these, 119 documents were reviewed.

Sampling

Sampling is a process of selecting events, a group of people or other typical elements that can be used to conduct a study (Grove et al 2012:364). Literature avails and differentiates between two types of sampling, namely probability and non-probability sampling. Non-probability sampling is a process of sampling in which not every element of the population stands a chance of being included in the sample. In qualitative studies the sample design can be used by the researcher to select those participants who can avail extensive information about the experience being studied (Grove et al 2012:371). The four types of non-probability sampling identified by Polit and Beck (2012:515) and Babbie (2010:193) are the quota, snowball, judgemental and purposive sampling methods. In this study purposive sampling was employed in the qualitative phase for the selection of the judicial and medical teams as well as for selecting the mentally stable male forensic psychiatric patients.

Purposive sampling

In purposive sampling the researcher specifies the attributes of a population of interest. The researcher then tries to locate the individuals who have those characteristics (Johnson & Christensen 2008:239; Polit & Beck 2012:515). The thrust of purposive sampling is to identify information rich individuals that will be instrumental in bringing out useful manifestations of the phenomenon of interest (Johnson & Christensen 2008:393).
The sampling criteria (also known as the eligibility criteria) include a list of typical attributes that are fundamental to the study. The sampling criteria contain an element of inclusion as well as exclusion criteria. Inclusion criteria are those attributes in a participant that should be present for him or her to be included in the study. Exclusion criteria are those characteristics that will render a participant not eligible for inclusion in the study (Grove et al 2012:364).
After the preliminary transcripts and field notes had been made available in the current study, the initial analysis was fed back into the data collection such that the sampling shifted from purposive to theoretical sampling. This was done to tie up any loose ends identified in the initial data through constant comparison (Gilbert 2008:85).In other words, theoretical sampling was employed during the study for constant comparison of the data that evolved.
Charmaz (2006:95; 2014:26) suggests that as tentative categories emerge the researcher needs to take a step back and revisit the empirical world to collect data that verifies the evolving categories and themes. In view of this advice, participants who had not been originally purposively sampled for this study were included because they needed to clarify some issues or grey areas that were raised by the mainstream participants. Theoretically sampled participants included relatives of the forensic psychiatric patients, a regional clerk of the court, an officer in charge of the special institution, a member of the Mental Health Review Tribunal and nurses from the unit in the civil psychiatric hospital who received forensic psychiatric patients from the special institution.
Inclusion criteria for the judicial and medical teams included that participants should share the characteristics listed below.
• They had to be directly involved in the care, rehabilitation or legal aspects relating to the forensic psychiatric patients.
• They had to be able to express themselves in Shona, isiNdebele or English
• They should not have been directly involved in the care, rehabilitation or legal aspects relating to forensic psychiatric patients but being an expert in forensic psychiatric rehabilitation practice.
The exclusion criteria pertained to:
• Medical staff and members of the judicial team who were not directly involved in the care, rehabilitation or legal aspects relating to the forensic psychiatric patients and were also not experts in forensic psychiatric rehabilitation practice.
The inclusion criteria for forensic psychiatric patients are set out below.
• Male patients who had already been admitted to the two special institutions at the time of the study. Males were chosen because they formed the bulk of forensic psychiatric patients and were cared for separately from criminal offenders.
• Patients had to be older than18 years. Special institutions in Zimbabwe do not admit any forensic psychiatric patients under the age of 18.
• The patients had to be mentally stable. The attending psychiatrist of the patients assessed each patient’s mental state to determine whether he was mentally stable.
Only patients, for whom the psychiatrist presented a written report to the Special Board to the effect that they were now mentally stable, were included as participants.
• Patients for whom the Special Board had written to the Mental Health Review Tribunal to the effect that they were ready for discharge.
• Patients had to be able to express themselves in Shona, IsiNdebele or English.
The exclusion criteria related to forensic psychiatric patients are presented next.
• Patients not admitted to special institutions were excluded because the focus of the study was on special institutions only.
• Mentally unstable psychiatric patients as indicated by the psychiatrist’s report; in other words, those patients for whom the psychiatrist had not yet written a report to the Special Board to the effect that they were stable at the time of the study.
• Forensic psychiatric patients who had relapsed despite having a psychiatrist’s report written to the Special Board to the effect that they were stable at the time of the study.
• Female forensic psychiatric patients were excluded because they were mixed with female criminal offenders making them not homogenous to their male counterparts

TABLE OF CONTENTS
CHAPTER 1 ORIENTATION TO THE STUDY
1.1 INTRODUCTION 
1.2 BACKGROUND TO THE RESEARCH PROBLEM
1.3 STATEMENT OF RESEARCH PROBLEM
1.4 AIM OF THE STUDY
1.5 SIGNIFICANCE OF THE STUDY
1.6 DEFINITIONS OF TERMS
1.7 FOUNDATIONS OF THE STUDY
1.8 RESEARCH DESIGN AND METHOD
1.9 RIGOUR IN RESEARCH
1.10 ETHICAL CONSIDERATIONS
1.11 OUTLINE OF THE CHAPTERS
1.12 SUMMARY
CHAPTER 2 LITERATURE REVIEW
2.1 INTRODUCTION 
2.2 APPLICATION OF LITERATURE IN THE STUDY 34
2.3 HISTORICAL OVERVIEW OF FORENSIC PSYCHIATRY IN DEVELOPED COUNTRIES
2.4 CURRENT LEGAL PROCEDURES FOLLOWED IN THE DETENTION AND TREATMENT OF FORENSIC PSYCHIATRIC PATIENTS IN DEVELOPED COUNTRIES
2.5 HISTORICAL OVERVIEW OF FORENSIC PSYCHIATRY IN DEVELOPING COUNTRIES
2.6 CURRENT LEGAL PROCEDURES FOLLOWED IN DETENTION AND TREATMENT OF FORENSIC PSYCHIATRIC PATIENTS IN DEVELOPING COUNTRIES
2.7 HISTORICAL OVERVIEW OF FORENSIC PSYCHIATRY IN ZIMBABWE
2.8 FORENSIC PSYCHIATRIC REHABILITATION IN DEVELOPED COUNTRIES
2.9 FORENSIC PSYCHIATRIC REHABILITATION IN DEVELOPING COUNTRIES
2.10 DISCOURSES IN FORENSIC PSYCHIATRY
2.11 SUMMARY
CHAPTER 3 RESEARCH DESIGN AND METHODS
3.1 INTRODUCTION
3.2 RESEARCH DESIGN
3.3 POPULATION AND SAMPLING
3.4 SAMPLING IN THE QUANTITATIVE PHASE
3.5 DATA COLLECTION
3.6 DATA ANALYSIS
3.7 TRUSTWORTHINESS OF THE QUALITATIVE PHASE
3.8 RELIABILITY AND VALIDITYOF THE QUANTITATIVE PHASE
3.9 PHASE 2: DEVELOPMENT OF A MEDICO-JUDICIAL FRAMEWORK
3.10 PHASE 3: VALIDATION OF THE MEDICO-JUDICIAL FRAMEWORK
3.11 SUMMARY
CHAPTER 4 QUALITATIVE FINDINGS OF THE STUDY
4.1 INTRODUCTION
4.2 DESCRIPTION OF THE DEMOGRAPHIC PROFILE OF THE PARTICIPANTS
4.3 DISCUSSION OF FINDINGS
4.4 SECTION A: CENTRAL STORYLINE AND THEMES FOR JUDICIAL TEAM
4.5 DISCUSSION OF FINDINGS
4.6 STAKEHOLDERS RECOMMENDATIONS
4.7 SUMMARY
CHAPTER 5 QUANTITATIVE RESULTS
5.1 INTRODUCTION 
5.2 STUDY SETTING
5.3 PERIOD UNDER REVIEW
5.4 LEGAL BASIS FOR ADMISSION OF FORENSIC PSYCHIATRIC PATIENTS
5.5 PREVIOUS ADMISSIONS IN SPECIAL INSTITUTIONS
5.6 PATIENT DIAGNOSIS
5.7 PREVIOUS MENTAL ILLNESS/ILLNESSES IN FORENSIC PSYCHIATRIC PATIENTS
5.8 AGE DISTRIBUTION OF FORENSIC PSYCHIATRIC PATIENTS
5.9 MARITAL STATUS DISTRIBUTION OF FORENSIC PSYCHIATRIC PATIENTS
5.10 LEVEL OF EDUCATION DISTRIBUTION FOR FORENSIC PSYCHIATRIC PATIENTS
5.11 CRIMINAL CHARGES AGAINST FORENSIC PSYCHIATRIC PATIENTS
5.12 SOURCE OF REFERRAL FOR FORENSIC PSYCHIATRIC PATIENTS
5.13 REHABILITATIVE INTERVENTIONS FOR FORENSIC PSYCHIATRIC PATIENTS
5.14 SERVICE OUTCOMES FOR FORENSIC PSYCHIATRIC PATIENTS
5.15 ASSOCIATION BETWEEN SEVERITY OF MENTAL ILLNESS AND CRIMINAL CHARGE
5.16 RELATIONSHIP BETWEEN CRIMINAL CHARGE AND PREVIOUS ADMISSION
5.17 ASSOCIATION BETWEEN CRIMINAL CHARGES AND REHABILITATIVE INTERVENTION
5.18 LINK BETWEEN CRIMINAL CHARGES AND TREATMENT GIVEN 223
5.19 RELATIONSHIP BETWEEN REHABILITATIVE INTERVENTIONS AND NUMBER OF PREVIOUS ADMISSIONS
5.20 SUMMARY
CHAPTER 6 DISCUSSION OF THE CURRENT STATE OF FORENSIC PSYCHIATRIC REHABILITATION IN ZIMBABWE
6.1 INTRODUCTION 
6.2 THE ‘REVOLVING DOOR’ PHENOMENON: THE VICIOUS CYCLE
6.3 THE CURRENT RELATIONSHIP BETWEEN THE SOCIAL FIELDS
6.4 THE JUDICIARY
6.5 THE NURSES
6.6 THE FORENSIC PSYCHIATRIC PATIENTS
6.7 RELATIVES OF FORENSIC PSYCHIATRIC PATIENTS
6.8 THE PSYCHIATRISTS
6.9 SUMMARY
CHAPTER 7 A MEDICO-JUDICIAL FRAMEWORK FOR THE REHABILITATION OF FORENSIC PSYCHIATRIC PATIENTS IN ZIMBABWE
7.1 INTRODUCTION
7.2 JUDICIARY PROCEDURES
7.3 STEP 5 ‒ THE FORENSIC PSYCHIATRIC HOSPITAL
7.4 STEP 6 ‒ SPECIAL BOARD AND MENTAL HEALTH REVIEW TRIBUNAL
7.5 STEP 7 ‒ HALFWAY FACILITY
7.6 STEP 8 ‒ COMMUNITY SERVICES
7.7 GUIDELINES FOR IMPLEMENTING THE FRAMEWORK: THE VISION OF A NEW MEDICO-JUDICIAL COSMOS
7.8 SUMMARY
CHAPTER 8 SUMMARY, CONCLUSIONS, LIMITATIONS AND RECOMMENDATIONS
8.1 INTRODUCTION
8.2 SUMMARY
8.3 CONCLUSION
8.4 LIMITATIONS OF THE STUDY
8.5 RECOMMENDATIONS
8.8 CONCLUDING REMARKS
BIBLIOGRAPHY
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