Oscar Pistorius Trial Day 33: Blade Runner's outpatient status 'extraordinary'

PRETORIA, South Africa – In less than a week, Oscar Pistorius must report to Weskoppies Psychiatric Hospital on the outskirts of the capital to begin his month-long psychiatric evaluation.

He will be assessed as an outpatient at the facility, starting at 9 a.m. Monday, Judge Thokozile Masipa ruled, a concession sources told Yahoo Sports is "extraordinary."

In a dark gray overcoat, Pistorius stood expressionless in the dock to receive Masipa's order Tuesday.

Masipa has requested that the Paralympian – accused of the premeditated murder of girlfriend Reeva Steenkamp in the early hours of Valentine's morning last year – present himself every weekday morning for seven hours, or until he is "formally excused" at the hospital, until court proceedings reconvene June 30.

Much is at the discretion of the psychiatric facility and the panel of four experts that will assess him: the duration of the observation periods, whether they will be conducted daily or only on weekdays, and where in the large Weskoppies facility they will take place.

The expert team can also request for an extension to the initial 30-day assessment period when the parties reconvene in court June 30.

Masipa has asked the panel to "inquire into whether the accused, by reason of mental illness or mental defect, was at the time of the commission of the offense criminally responsible for the offenses charged" when he shot and killed Steenkamp through a locked door.

Is Pistorius getting special treatment?

Llewellyn Curlewis, president of the Law Society of South Africa, says being referred for observation as an outpatient "isn't unlikely, it's extraordinary."

In her May 14 ruling for referral, Judge Masipa requested for Pistorius to be treated as an outpatient, if possible, saying, "The aim of referral isn't to punish the accused twice."

Psychiatric experts say such an observation period with the subject as an outpatient isn't as effective and have raised concerns about how this could set a precedent for other cases.

Dr. Saths Cooper, a well-respected clinical psychologist and senior lecturer in forensic psychology, told Yahoo Sports that the usual 30-day in-patient assessment has been "tried and tested, drawn from years of best practice," and Masipa's decision is a "serious deviation which could impact on the results obtained and compromise the outcome."

Cooper says Pistorius' limited outpatient hours raise various problems, preventing the professionals evaluating him from getting "a complete picture of the subject."

Overnight or in-patient observation allows experts to examine the athlete's habits, including his sleeping patterns, his eating habits, his interaction with other patients in the facility, and nursing and custodial staff, and overall physical and emotional behavior, Cooper said.

Cooper, who was imprisoned with the late Nelson Mandela on Robben Island in Cape Town, says a custodial observation period allows for more effective assessment.

"Confinement brings up issues which are stressful," Cooper said. "And the professionals observing an individual will be able to make conclusions on how they deal with those different issues. They rely on an individual's entire behavior during that period."

Regarding the possible break in Pistorius' observation over weekends, Cooper said: "This entire thing is unusual. And the judge has opened a door now that can allow for exceptions."

"Most psychiatric professionals worth their salt would be fairly concerned with the current ruling," he said, "because it takes away from their professional realm."

Most crucially, Cooper said, the decision to assess Pistorius as an outpatient may raise serious questions about any verdict influenced by the panel's findings "because of just how unusual the circumstances are" for his observation.

In the wake of Masipa's May 14 ruling referral, there have also been concerns from mental health groups around an apparent increase in misinformation and misunderstanding about mental illnesses such as generalized anxiety disorder (GAD).

"Due to recent developments, people who suffer from GAD are becoming scared of stigma and the reaction of others, and concerned that they or a loved one are potentially dangerous," the South African Depression & Anxiety Group said in a statement.

How will it work exactly?

Pistorius must "present himself" for assessment at Weskoppies Psychiatric Hospital, the biggest of its kind in the country.

The facility is the oldest psychiatric hospital in the province, admitting its first patient in 1892 and only integrating black and white wards in 1991.

Questions remain as to which part of the hospital Pistorius will spend his evaluation period in. Most observations of court-referred patients take place in the maximum security ward, ringed by high raw concrete walls. But given the former Olympic star's outpatient status, the celebrity athlete may be assessed in a different area.

The exact components of Pistorius' assessment will be determined by the four-person panel of mental health specialists appointed by the court, but they will likely include lengthy interviews to analyze his full life, family and psychiatric history; a range of psychological tests, including personality, neuropsychological and general cognitive tests; and detailed observation of his every move, and his appearance, behavior and attitude during the procedures.

Who will perform the evaluation?

Masipa's ruling details a team of four experienced specialists who will conduct Pistorius' psychiatric assessment. The panel includes three psychiatrists – two of whom are based at Weskoppies – and one psychologist. It also includes an expert nominated by the defense.

The defense has chosen Dr. Leon Fine, a panel psychiatrist who assesses individuals referred for this kind of observation at Sterkfontein – the other such facility near Johannesburg – and specializes in anxiety syndromes.

On behalf of the court is Dr. Herman Pretorius, a Weskoppies psychiatrist who has also previously been appointed by the court to do such evaluations, including in a high-profile case of a convicted prisoner who slit two nurses' throats in 2005.

Clinical psychologist Jonathan Scholtz, head of psychology at Weskoppies, is also on the panel. He is also an adjunct professor at the nearby University of Pretoria's Department of Psychiatry.

Another Weskoppies psychiatrist – according to the law, either the medical superintendent, or someone appointed by the facility – will also join the expert team.

The panel will also be permitted to read the court record of the trial to guide its assessment.

Once each member of the panel has concluded his or her procedures, they will meet and together formulate a diagnosis. At the end of the observation, they are required to put together a comprehensive report of their findings, which need not be unanimous. If there's disagreement, each expert must give his or her individual findings on the matter.

What happens to the experts' report?

According to the law, the report from the panel must include a description of the nature of the inquiry, a diagnosis of Pistorius' mental condition, and "a finding as to the extent to which the capacity of the accused to appreciate the wrongfulness of the act in question, or to act in accordance with an appreciation of the wrongfulness of that act was, at the time of the commission thereof, affected by mental illness or mental defect or by any other cause."

But when Pistorius appears in court on June 30, after his month of psychiatric evaluation, the public may still not be made privy to his state of mind when he shot and killed Steenkamp.

Three copies of the comprehensive report compiled by the panel will be submitted after the 30-day period of observation: one to the defense, one to the prosecution, and one to the court.

The contents of the document are not made public, but according to South Africa's Criminal Procedure Act, they "shall be admissible in evidence at criminal proceedings."

It does not automatically become a matter of court record and will only be submitted as evidence at the discretion of either legal team – if it wants to enter it into the enormous cache of exhibits.

How important is this assessment?

Very.

The panel of experts assessing Pistorius will have to answer two main questions: whether he "was capable of appreciating the wrongfulness of his act," and if he were capable of "acting in accordance with an appreciation of the wrongfulness of his act."

Legal experts say that if the answer to either of those questions is "no," and if the murder-accused is deemed to entirely lack "criminal responsibility" – being too incapacitated by his mental illness – then there will be no verdict, and the case will be thrown out of court.

If that's the case, Pistorius would be institutionalized in a psychiatric facility until his treatment team decides he is no longer a danger to society – a period that could be as short as a few days, or as long as a few years.

But until now, that has not been Pistorius' defense.

The athlete has testified that he shot out of an "overwhelming" fear, suggesting a legal defense of "putative self defense," which could allow the court to find him guilty of "culpable homicide" – the South African equivalent of manslaughter, which carries no mandatory custodial sentence – instead of murder.

If the panel of mental health specialists finds that Pistorius' alleged generalized anxiety disorder had an impact but did not completely remove his "criminal responsibility" for his behavior on Valentine's morning, Curlewis says it can be used as an argument for a mitigated sentence, or even be considered by the judge as a factor in reaching her verdict.

If the panel's findings are similar to those of psychologist Merryl Vorster – the last witness – this observation period will benefit the defense, especially considering that Masipa has already said Vorster's testimony was "in line with the accused's evidence."

If the panel disagrees with Vorster, it's a significant gain for the prosecution, which insists Pistorius shot Steenkamp with a clear mind and in cold blood.

Arguments will continue when court proceedings resume on June 30.

Pistorius' defense team has now indicated, despite previous suggestions it had very few witnesses left – Roux initially estimated it would call 14 to 17 witnesses; it has so far called 12 – that it may need more than a week to complete presenting its evidence.

Once testimony is finished, court proceedings are then expected to be postponed for several weeks to allow both sides to put together and submit their written arguments before meeting again to present their closing arguments in court.

A verdict in the matter is not expected before late August.