The curriculum in 2017 had been in use for 4 years. Overall, the curriculum was well received and appears to have resulted in appropriate achievement of the knowledge and skills described in the curriculum. Additional training appears necessary in the domains of advocacy and delivering court evidence.
The students’ perceptions of their attitude towards the assessment and treatment of mentally ill offenders was impartial. Training in being Impartial in assessment and management runs across all the different disciplines of Psychiatry as stigma is a barrier in psychiatry as a whole (16). The students have impartiality drilled in them during psychiatric training from year 1 of the MMed programme.
There is a need to strengthening advocacy training by introducing additional skills training in awareness-raising, training, counselling, mediating, defending, and denouncing in mental health. We hope to do this by addition additional role playing, development of Information and Communication Technology (ICT) material, writing ‘opposite the editorial page’ Op-Eds and media presentation (17).
The low confidence levels noted in court appearance, report writing and giving evidence as an expert witness could be due to these aspects being new to them. In addition, it may also reflect incomplete implementation of the desired curriculum-specifically failure to implement mock trials. This can be strengthened by more use of role-play in the implementation of the curriculum
We plan to start forensic training earlier, increase visits to courts and prisons, carry out peer reviews of resident work in these spaces, and implement the moot courts in order to improve their competency levels.
Impact on forensic psychiatry and provision of services
As of 2017, three of the six Psychiatrists who graduated, work in the forensic psychiatric units. Two are permanent and one is working on a voluntary basis. The forensic psychiatric institution has approximately 200 to 300 mentally ill alleged offenders waiting to be evaluated. The training has tripled the number of psychiatrists attending to forensic services in Zimbabwe.
Challenges and Barriers
There have been challenges since 2018 getting permission for students to access the forensic psychiatric institution due to changes in security clearance protocols. This has resulted in the clinical aspect being done in the general psychiatry outpatient clinic where the Police often bring one or two psychiatric offenders for court assessments. This means MMed clinical exposure is reduced and less structured.
The arranging and co-coordinating of mock court sessions with the judiciary system who are very busy and have back logs has been a challenge. These types of simulated encounters were intended to be done for 3 hours over the 4 months, however they have not been implemented yet. The students wait until they have their first court case subpoena as an expert witness before they are in a court setting.