Peer support, i.e. the involvement of individuals with similar experiences of illness and life circumstances as the patients themselves, remains rare in forensic psychiatry in Germany. Administrative obstacles and preconceptions from professionals of other disciplines often hinder its implementation. At the Hospital of Forensic Psychiatry of Rostock University Medical Center, two focus groups with staff and semi-structured interviews with external clinic directors and peer support workers were conducted in preparation for introducing peer support. The aim was to gather perspectives on the benefits, challenges, expectations, and experiences associated with this approach. An inductive thematic analysis of the data identified key themes such as preparation, trust, lived-experience and professionalism. Findings revealed that the unique professional role of peersupport workers-offering expertise based on personal experience-often leads other professionals to question their reliability, resilience, and professional competence. However, participants also recognized the potential of peersupport to reduce stigma toward forensic patients and to ultimately improve the quality of care provided.
As long as the state interferes with someone's personal freedom, it is also responsible for this person's health care. Doctors and nurses in penal institutions play a key role in this process. The challenges faced by the various professional groups have steadily increased in recent years, while working for the justice administration has in turn become less attractive. Staff shortages and limited resources add to the pressure of working in prisons and make it more difficult to fulfil the mandate to provide care. Many of the statements and recommendations of the national Ombudsman Board in its function as a controlling body and National Preventive Mechanism for the penitentiary system and forensic institutions in Austria can also be applied to the situation in Germany and Switzerland.
The present study examines differences between patients with full criminal responsibility and patients with significantly diminished criminal responsibility in forensic psychiatric treatment pursuant to section 64 of Germanys' criminal code (StGB). The focus is on psychological characteristics that may play a role in forensic assessment practice when evaluating the severity of mental disorders and their impact on social adaptability. The sample comprised N = 220 individuals. The variables recorded included the preferred substance of abuse (ICD-10: F10-F19), social skills (ISK), sociallycompetent behaviour (GAF, BZR), psychopathy (PCL-R), emotional processing ability (EPS), and intelligence (WAIS-IV). Additionally, moderated effects were examined. The association between preferred substance and criminal responsibility assessment was tested using Fisher's Exact Test; the remaining predictors were included in a logistic regression analysis. Significant associations were found for preferred substance (p < .001), the numberof BZR entries (p = .025), GAFscore (p = .018), and intelligence (p = .020), although the direction of the intelligence effect did not correspond to the hypothesis. A higher criminal record burden and a lower GAF score were associated with an increased likelihood of being assessed as & raquo;substantially diminished criminal responsibility & laquo;. The findings indicate differences in stable psychological characteristics between individuals who, based on the court's assessment, were classified as fully criminally responsible versus as having substantially diminished criminal responsibility. The results should be understood as exploratory indications for group-level associations between such characteristics and existing criminal responsibility classifications and do not allow conclusions about the individual mental state at the time of the offense in individual cases.
The investigation of dynamic predictors of recidivism in patients who undergo mandatory forensic addiction treatment has been insufficiently examined. One dynamic factor could be the consumption pattern during treatment. Consumption behavior has not yet been conclusively conceptualized. This qualitative study examined the components of consumption patterns via 17 interviews with patients, who underwent mandatory treatment in a forensic psychiatric hospital in Germany and two focus groups with employees of the same hospital. Results show different patterns: temporal, observed and internal. A temporal pattern can be divided into five overarching types (progressive, regressive, constant, intermittent, chaotic).Internal patterns of factors within and outside the patient constitute the observed consumption patterns. The reflection of the observed behavior allows therapeutic intervention points. Future studies should validate the components and further investigate the relationship between certain patterns of consumption behavior and recidivism.
In many aspects, the data situation on the placement and treatment in forensic psychiatric hospitals in Germany is unsatisfactory. Well-founded empirical research on key issues in forensic institutions often only has access to regionally and thematically limited data. Our study on the so-called Kerndatensatz (KDS-set of core data) and its progress illustrate significant obstacles to research, a lack of transparency and a lack of information on key issues relating to the quality of accommodation, treatment and therapy. This situation does not meet the requirements of constitutional law. Greater attention and more far-reaching initiatives, particularly in terms of legal policy, are needed to improve the unsatisfactory situation.
The recent amendment to Section 64 of the German Penal Code (StGB) nowrequires an expected prospectoftreatment success based on actual indications, further emphasizing the importance of valid predictors for the effectiveness of addiction treatment in offenders. Previous research in this area suggests that the success of treatment in forensic addiction facilities is largely influenced by dynamic factors, which are inherently difficult to predict. This study is the first to investigate the patient perspective, aiming to identify subjective factors influencing treatment success from the viewpoint of 21 successfully treated forensic addiction patients under Section 64 StGB in North Rhine-Westphalia. A mixed-methods approach was employed, incorporating semi-structured interviews to gather qualitative insights on treatment effectiveness as well as quantitative data from standardized questionnaires. The results support previous findings on the efficacy of forensic addiction treatment and suggest that even initially unmotivated patients can develop motivation and successfully complete therapy. Key influencing factors include previously overlooked dynamic treatment variables such as the therapeutic community and the milieu of a particular ward. Additionally, the therapeutic relationship is highlighted as a crucial component of treatment success and is deemed essential for fostering motivation.
The Nazi >> euthanasia << crimes were covered up by the judicial authorities in Germany. In a conference in April 1941, the chief public prosecutors and presidents of the higher regional courts of the German Reich were informed by the Reichs' MinistryofJustice about the mass murders and obliged to remain silent, including the Oldenburg authorities Dr. Rudolf Christians and Dr. Kurt Reuthe. In 1965, Fritz Bauer brought charges ofaiding and abetting murder against these > colleagues <. The events are presented from three perspectives-the historical course of psychiatric crimes, the behaviour of the judiciary and the legal reappraisal after 1945-comparing the national and regional Oldenburg level.
Participatory research enables persons with lived experience to share their perspectives while promoting social justice and empowerment. Despite its proven effectiveness, it is still in its early stages in forensic psychiatry. Therefore the perspectives of forensic patients are largely excluded. This article examines the attitudes and experiences of 15 forensic patients regarding participatory research, based on two focus groups. The thematic analysis identified four main categories: 1. Understanding, 2. Experiences, 3. Opportunities and Challenges, 4. Participatory Advisory Board. The analysis shows that involving forensic patients in participatory advisory boards is feasible but challenging, with success largely dependent on appropriate framework conditions. Such boards can enrich research and support the recovery process. To strengthen patients in their role, standardized training programs are needed to build research competencies. Additionally, political measures are essential to structurally promote participatory research.
Since 1977, the Austrian Ombudsman Board has been monitoring and controlling the entire federal public administration. It acts on the basis of complaints or on its own initiative. The AOB offers consultation days in all the provinces. They are held at the offices of authorities, but also in prisons, forensic-therapeutic centers and the forensic departments of psychiatric hospitals. In 2012, the Austrian Ombudsman Board was entrusted with the tasks of the National Preventive Mechanism. In this capacity, it monitors places of deprivation of liberty with the help of experts from various professional groups to ensure compliance with human rights. This article provides insights into the working methods of this monitoring body and its broad range of competences.
Backround: In Berlin, the proportion of preliminary detained forensic patients under 126a StPO is high and increased following the amendment of 63 StGB in 2016. The subject of this research was the analysis of changes in offense-related and pretreatment characteristics as well as the placement results from 2017 to 2022. Methods: Retrospective analysis of all 662 patients admitted to the Berlin forensic psychiatric hospital (KMV) during the study period. Results: Admissions under 126a StPO did not increase significantly, but the proportion of resulting orders under 63 StGB did. Parole discharges under 67b StGB were comparatively rare and continued to decline. There was no evidence of a change in reporting behavior or admissions for petty offenses. Patients with comorbid schizophrenia and addiction were predominantly admitted. Despite numerous previous treatments, only a few patients were in general psychiatric treatment at the time of the offense. Conclusion: Preventive approaches should address this forensic-psychiatric risk clientele. The reasons for the low number of parole releases could also lie in the field of psychosocial care or in legal decisions, and this is where further research should be undertaken.
In this article, the authors discuss whether the dual mandate of psychiatry, with its simultaneous aims to support and control/ protect represents in itself a contradiction. The authors reflect on this issue in a collaborative writing process, with reference to their different respective knowledge and expertise, based on personal or family experiences of crisis situations and psychiatric inpatient treatment, their work as peer and recovery workers, or as academics researching the topic of coercion and ethics in psychiatry. A central focus of the article is on how diverse the legal dual function of psychiatry is experienced in practice and how differently the underlying concepts of safety, protection, self-determination and support are understood individually.
In Germany, there has been a significant increase in admissions to forensic psychiatric institutions in accordance with Section 63 of the Criminal Code. Individuals with a foreign nationality account for the largest share of the overall increase. It was investigated whether the case characteristics differ depending on nationality. For this purpose, a comprehensive legal data set (German penal enforcement statistics) was analysed over a period of seven years (N = 6,490) (descriptive full survey with linear trend analyses). A differentiation by federal state reveals regionallydiffering trends in the proportion of individuals with foreign nationality. These differences have only a minor influence on the analysed case characteristics. Overall, nationality shows hardly any systematic correlation with the case characteristics.
Individuals of other nationalities have contributed significantly to the increase in placements under Section 63 of the German Penal Code since 2016-resulting in a significant increase in occupancy in Germanys' forensic psychiatric hospitals. Data on all new orders (n = 6,490) under Section 63 in Germany are available for the period of the increase until 2021. Hypotheses on the background of this development were tested, taking into account population development, the L & auml;nder-specific incidence rates and in comparison with other significant criminal sanctions of two years'imprisonment or more (Section 64 German Penal Code; n = 14,135, penal system n = 60,550). The case characteristics of the new sentences under Section 63 were presented in a separate paper (Ross & Traub 2025/1). A complete descriptive survey was conducted over a period of seven years. The comparisons were formulated on the basis of a linear trend analysis of new orders or convictions from 2015 to 2021 and a conversion into L & auml;nder-specific >> incidence rates <<. The L & auml;nder were grouped together for comparison purposes. In the previous findings, the analyses in the group of patients detained under Section 63 show hardly any differences in the case characteristics for different nationalities. However, the frequency of hospitalisation under Section 63 and the incidence rate for individuals of other nationalities are significantly higher in all federal states (L & auml;nder), with an upward trend. L & auml;nder-specific developments are more indicative of different mental health services than of criminal law tendencies towards foreign offenders. In the groups of other sanctions, the incidence of foreign nationals committing serious offences is even higher.
In cooperation with the Working Group on Juvenile Forensics, the detention arrangements of nine juvenile forensic psychiatric institutions were evaluated. The sample included 351 persons who were treated in accordance with 63 of the German Penal Code between 2009 and 2022. Differences up to 60 % were found between hospitals with regard to the granting of privileges. Based on these descriptive results, expert interviews were conducted. Results: the granting of privileges in forensic psychiatric detention of juveniles is not based solely on characteristics of inmates, state legislation and the attitude of the regulatory authority, but also on the organizational framework of the institution, the hospital management and the therapeutic team.
The expression of psychopathy-traits and frankness as well as the personality structure play a major role in addiction treatment of patients detained in accordance with Section 64 of the German Criminal Code because, among other things, the type and scope of psychotherapeutic measures can be derived from this. The present study examines such differences using a sample of n = 166 patients. Four different clusters emerged within which asimilar need for treatment can be assumed, but which differ significantly from one another. In practice, the results offer the opportunity to think about different therapy programs for the different clusters and to combine homogeneous therapy groups. Prospective studies could examine the high-risk group of patients with a high level of psychopathytraits and low frankness regarding responsiveness to therapeutic measures and the question of how these could be designed.
The accurate assessment of recidivism risk among sex offenders, coupled with a reliable diagnosis of paraphilic disorders, is of paramount importance in forensic evaluations and necessitates the integration ofmultiple sources ofinformation. This article provides a comprehensive reviewof various prognostic and diagnostic methods grounded in offense behaviour and demonstrates their practical application through detailed case studies. The research findings presented herein underscore the utility ofoffense behaviour indicators in predicting sexual offense recidivism. Specifically, the Crime Scene Behavior Risk Measure, along with several recidivism-relevant behavioural themes, have demonstrated incremental validity when compared to the Static-99R. This suggests that a combination of second-generation risk assessment tools and offense behaviour- based indicators offers a more precise assessment of recidivism risk. Given the recognized limitations and low reliability associated with clinical diagnoses of conditions such as pedophilic disorder and sexual sadism, this paper advocates for the use of the offense behaviour diagnostic screening procedures - namely, the SSPI, SSPI-2, SSPC, and SeSaS - as supplementary diagnostic tools, aligned with the principle of convergence. These procedures have the potential to enhance clinical diagnostics by ensuring the transparency and comprehensibility of the underlying criteria. Despite some of these methodologies being developed over two decades ago, their integration into forensic practice remains insufficient. The case studies presented in this article are intended to exemplify the practical application of these approaches and to encourage their broader
In Germany, forensic aftercare outpatient clinics provide outpatient treatment for those released from prison. This study conducted by the Centre for Criminology (KriminologischeZentralstelle- KrimZ) surveyed forensic outpatient clinics under the direction of the federal states' Ministries of Justice, which provide aftercare for prisoners. An online questionnaire created in cooperation with the Working Group of the Federal Association of Prison Based Forensic Outpatient Clinics (Bundesarbeitsgemeinschaft Forensische Ambulanzen des Strafvollzugs, BAG-FORAS), was sent to respective institutions treating individuals released from prison. The survey examined the institutional structure, therapeutic approaches, diagnostic and prognostic procedures, characteristics of treated individuals, and current requirements. The key findings are discussed in the context of current standards of forensic aftercare.
Objective Comparison of assaults against staff on four psychiatric wards 12 months before and after the opening of a secured open space. Methods Recording of aggression events using SOARS and file analysis 12 months before and after the opening ofa secured open space (t1: N = 1075 patients, t2: N = 1008 patients). Comparison of assaults (t1: N = 91, t2: N = 60) using statistical analyses. Results chi(2) test shows a significant difference in assaults against staff before and after access to the garden (p = .027). Odds ratio indicates that the occurrence of assaults without access to secured open space is almost 1.5 times higher (p = .028). Differentiated between early, late and night shifts, the strongest association becomes evident in the latter. Conclusion So far, only Berlin and Bremen legally require every psychiatric facility to offer access to a secure open space available. The data presented here empirically point to the de-escalating effect of such secured open spaces. Hence, all German federal states should urgently consider a legal regulation to this effect.
Judges who have to decide on proceedings in guardianship and mental health law matters (Sections 271 - 341 FamFG) base their decisions, which often severely infringe on the rights of the persons concerned, primarily on the available medical opinions. This applies to decisions on guardianship, involuntary placement, involuntary treatment and measures of restraint. The quality and validity expert opinions is rarely scrutinised. In order to facilitate a judicial review of the expert opinion, generally applicable standards should be developed - possibly taking into account thematic particularities. In this respect, guardianship law in Germany has not yet progressed beyond tentative approaches. Statutory provisions, case law and legal literature merely provide some starting points.
Studies on compulsory drug treatment are only available to a very limited extent in forensic psychiatric hospitals and prisons. This full survey study included 35 patients in the Hospital for Forensic Psychiatry (KMV) and in the Department of Psychiatry and Psychotherapy of the Prison Hospital (JVK) in Berlin who were scheduled for compulsory treatment in accordance with state regulations in the years between 2017 and 2021. This was carried out for five out of nine patients at the JVK and 22 out of 26 patients at the KMV. The groups were examined for possible factors influencing coercive measures and compared using a validated prediction tool (Forensic Psychiatry Violence Oxford (FoVOx)) to predict violent behavior. In both groups, the majority had a schizophrenia spectrum disorder. The group comparison showed differences with regard to age structure, offenses and substance use disorders. In the risk assessment, the majority of patients in the KMV were assigned to a low or medium risk group for violent behavior, while those in the JVK were assigned to a medium to higher risk group.
