https://ir.unisa.ac.za/handle/10500/5693 2026-05-12T21:36:24Z 2026-05-12T21:36:24Z Pazaropoulos-Koot, Stella Mahommed, Safia Pienaar, Letitia https://ir.unisa.ac.za/handle/10500/32442 2026-05-08T06:17:56Z 2025-04-01T00:00:00Z

Facilitating a framework for managing rare diseases inSouth Africa: Comparative insights from the UK and Italy Pazaropoulos-Koot, Stella; Mahommed, Safia; Pienaar, Letitia Managing and treating rare diseases is a global concern, largely because of their rarity and the complexities associated with their care.Robust ethico-legal frameworks governing rare diseases are essential as they establish coordinated guidelines that ensure patients receivethe care and support which they require. This article examines and compares the existing frameworks for rare diseases in the UnitedKingdom and Italy, with those in South Africa (SA), highlighting the differences and similarities in how they operate, towards facilitatinga national framework that suits our context. The recommendations offer proposed solutions to add to the ongoing dialogue regardingthe current lack of governance for rare diseases in SA. The article further calls for a coherent national framework to better address andrepresent the needs and rights of individuals affected by rare diseases. SA requires a systematic approach, with clear guidelines fordiagnosing, treating and funding rare diseases. This approach would establish a basis for efficient resource allocation and equitable accessto essential treatments.

2025-04-01T00:00:00Z Pienaar, Letitia Ogunwale, Adegboyega Oluwaseun, Oluwaranti https://ir.unisa.ac.za/handle/10500/32441 2026-05-08T06:11:42Z 2023-01-01T00:00:00Z

Plausible subjective experience versus fallible corroborative evidence: The formulation of insanity in Nigerian criminal courts Pienaar, Letitia; Ogunwale, Adegboyega; Oluwaseun, Oluwaranti Insanity as a defence against criminal conduct has been known since antiquity. Going through significant reformulations across centuries, different jurisdictions across the globe, including Nigeria, have come to adopt various strains of the insanity defence, with the presence of mental disorder being the causative mechanism of the crime as their central theme. A critical ingredient in the Nigerian insanity plea is the presence of ‘mental disease’ or ‘natural mental infirmity’ as the basis for the lack of capacity in certain cognitive and behavioural domains resulting in the offence. Mental disorders, which are the biomedical formulations of this critical legal constituent are primarily subjective experiences with variable objective features. Using illustrative cases based on psycho-legal formulation as well as reform-oriented and fundamental legal research, it is shown that Nigerian courts have held that claims of insanity based on the accused person’s evidence alone should be regarded as “suspect” and not to be “taken seriously.” Thus, Nigerian judicial opinions rely on non-expert accounts of defendants’ apparent behavioural abnormalities and reported familial vulnerability to mental illness, amongst other facts while conventionally discountenancing the defendants’ plausible phenomenological experiences validated by expert psychiatric opinion in reaching a conclusion of legal insanity. While legal positivism would be supportive of the prevailing judicial attitude in entrenching the validity of the disposition in its tenuous precedential utility, legal realism invites the proponents of justice and fairness to interrogate the merit of such preferential views which are not supported by scientific evidence or philosophical reasoning. This paper argues that disregarding the subjective experience of the defendant, particularly in the presence of sustainable expert opinion when it stands unrebutted is not in the interest of justice. This judicial posturing towards mentally abnormal offenders should be reformed on the basis of current multidisciplinary knowledge. Learning from the South African legislation, formalising the involvement of mental health professionals in insanity plea cases, ensures that courts are guided by professional opinion and offers a model for reform.

2023-01-01T00:00:00Z Pienaar, Letitia https://ir.unisa.ac.za/handle/10500/32440 2026-05-08T06:01:25Z 2025-03-18T00:00:00Z

The Evolution of Mental Health Legislation in South Africa: Towards a Rights Based Approach Pienaar, Letitia This contribution examines the human rights framework and legislative developments in South Africa on persons with mental illness, revealing that the initial focus of the legislation was on control and detention at the cost of the rights of mental health care users. Presently, under its Constitutional democracy, South Africa has progressive Mental Health Legislation focusing on the rights of mental health care users and the least restrictive means of treatment. The contribution considers the impact of the legislative developments on the human rights of mental health care users. There are, however, challenges with the implementation of the legislation most notably illustrated by the Life Esidimeni disaster where a mass deinstitutionalization project led to the loss of life. South Africa’s revised Mental Health Policy Framework holds a renewed commitment to respect a mental health care user’s right to dignity, integrity, privacy, and freedom of movement. This is one step closer to the realisation of the obligations created by the United Nations Convention on the Rights of Persons with Disabilities (CRPD). The contribution considers the 2018 concluding observations by the United Nations Committee on the Rights of Persons with Disabilities, which lays bare areas where yet further improvement is needed in South Africa to eradicate all forms of discrimination against persons with disabilities and, in particular, persons with mental illness Areas where progress have been made are highlighted. South Africa has made steady progress but needs to intensify its efforts to domesticize the CRPD.

2025-03-18T00:00:00Z Pienaar, Letitia https://ir.unisa.ac.za/handle/10500/28610 2022-05-24T07:43:58Z 2021-01-01T00:00:00Z

Considering Mental Health Courts for South Africa: Lessons from Canada and the United States of America Pienaar, Letitia Under the South African criminal justice system, mentally ill persons in conflict with the law spend long periods awaiting forensic assessment, owing to resource shortages (staff and available beds). Accused persons awaiting forensic assessment are often kept in correctional facilities where mental health care services are lacking. This leaves many accused individuals who are mentally ill at risk of falling between the proverbial cracks of the system. The diversion of the accused with mental illness from the criminal justice system into a treatment programme could address this problem. Currently no such formal diversion option exists in South Africa. Mental health courts as a formal diversion option are gaining popularity in jurisdictions such as Canada and the United States of America, where delays with forensic assessments and, in particular, pre-trial fitness assessments are rife. These courts employ therapeutic jurisprudence to deliver justice. This contribution explores the nature of a mental health court and looks at such courts in Canada and the United States of America and considers whether South Africa could benefit from such a court and whether it would be viable within the South African legislative framework.

2021-01-01T00:00:00Z