Addiction and mental health in focus ahead of Usindiso confession ruling

The case of Sthembiso Mdlalose, accused of starting a fire which killed 76 people in a Johannesburg building, has shed a spotlight on how the justice system deals with offenders battling long-term drug addiction and possible mental health challenges.

Judgment is expected to be delivered in the Palm Ridge magistrate’s court on Wednesday.

Mdlalose is accused of starting the fire at the Usindiso Building in the Johannesburg CBD in August 2023, which claimed the lives of 76 people. He faces 76 counts of murder, 86 counts of attempted murder and a charge of arson.

The self-confessed drug addict told the court he had been smoking crystal meth, commonly known as tik, for more than 10 years. He also claimed he was heavily intoxicated when he testified before the Khampepe commission of inquiry and later made a confession.

Mdlalose has since withdrawn the confession, alleging that he was pressured into taking the blame by an alleged drug dealer known as “Master”.

But the court ruled in May last year that his confession was admissible as evidence.

Khulisa Social Solutions founder and MD Dr Lesley Ann van Selm said people with long histories of substance abuse would usually undergo assessments to determine how addiction may have affected their thinking and behaviour.

“In cases involving long-term substance abuse, professionals would typically seek to establish the extent and nature of the individual’s addiction, the impact of substances on cognitive functioning, and whether there are any underlying mental health conditions.”

She said specialists may assess a person’s memory, judgment, impulse control and decision-making ability.

“Where intoxication at the time of a confession or statement is alleged, forensic psychologists and psychiatrists may also be asked to assess whether the person’s mental state could have affected their understanding, recall, or ability to provide reliable information.”

Van Selm said offending behaviour is often linked to a number of challenges happening at the same time.

“Substance abuse, trauma, adverse childhood experiences, mental health challenges, social exclusion and dysfunctional environments frequently overlap.”

Because of this, she said rehabilitation should focus on more than just the crime itself.

“As a result, effective rehabilitation generally requires a holistic and multidisciplinary approach.”

According to the department of correctional services, psychological services are aimed at helping offenders adjust to correctional facilities, develop healthy coping skills and reduce the risk of reoffending. Treatment may include:

• individual counselling;
• group therapy;
• substance abuse programmes;
• family interventions and;
• psychiatric care where necessary.

Van Selm said the type of treatment offered depends on the individual’s needs and may include counselling, behavioural change programmes, social work support and restorative justice processes.

“The emphasis is usually on understanding and addressing the root causes that contributed to the individual’s behaviour rather than focusing solely on the offence itself,” she said.

There have been ongoing concerns about limited mental health resources in the correctional system.

Earlier this year, parliament heard that the number of declared state patients being held in correctional facilities while waiting for placement in mental health institutions had increased to 309 by the end of February 2026, up from 186 in the 2019/20 financial year.

The portfolio committee on correctional services also heard that South Africa has 14 designated health facilities for state patients and about 942 psychiatrists, with roughly 75% working in the private sector while most patients rely on public healthcare services.

Committee chairperson Kgomotso Anthea Ramolobeng warned that declared state patients are a vulnerable group whose rights must be protected while ensuring public safety. The committee also raised concerns about overcrowding in mental health facilities, delays in reviews and shortages of specialised mental health resources.

Van Selm said meaningful rehabilitation is most successful when it addresses the person’s full circumstances.

“From Khulisa’s experience, sustainable behavioural change is most likely when treatment addresses the whole person and the broader circumstances that have shaped their life experiences, rather than treating addiction, mental health, or offending behaviour in isolation,” she said.

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