Court sentences to forensic-psychiatric treatment and imprisonment in Germany: Types of crimes and changes from 1995 to 2009.

The management of mentally disordered offenders varies widely across countries. Given the high prevalence of individuals with mental disorders throughout the criminal justice system, it is not always clear why some people receive forensic treatment and others a prison sentence. This project investigated trends in criminal justice sentencing practices in Germany from 1995 to 2009. We analysed officially recorded data taken from 14,100,329 court rulings to describe differences in the index offences committed by individuals sentenced to prison of at least two years and those given a forensic treatment order. The distribution of offence types differed substantially. Forensic patients committed 6.6% of all severe crimes. There was a 50% increase in the number of forensic treatment orders compared to a 11.6% increase in the group of individuals sentenced for crimes of a similar severity. Forensic patients were more likely to have committed a serious offence. This paper provides key epidemiological data and offers a basis for future comparative research. It also concludes that these trends are indicative of a moderate penal policy, without a drift towards penal populism arguably visible in other jurisdictions. Instead, it is argued that the findings are consistent with actuarial social control policies oriented towards risk prediction and crime prevention of high-risk offender groups.

Comparison of offenders in forensic-psychiatric treatment or prison in Germany.

PURPOSE: Arrangements for the management of mentally disordered offenders vary widely across countries, as do rates of imprisonment and detention in forensic-psychiatric settings of such individuals. This study aims to quantify the characteristics of offenders detained in forensic-psychiatric settings in Germany over a 15 year period from 1995 and compare these with those sentenced to imprisonment over the same period. METHODS: Using official national statistical data, the index offences, demographic characteristics and criminal histories for all individuals convicted to forensic-psychiatric detention during the study period are described together with changes over time. This group was then compared with offenders convicted to a prison sentence of at least two years in the same time period for equivalent offences. RESULTS: Relevant differences and similarities between the two treatment groups were identified. Compared to offenders in prison, those in forensic care were older, with a higher proportion of women and a lower proportion of those with foreign backgrounds. Significant previous offending and levels of diminished responsibility were present in both groups. CONCLUSIONS: These findings provide data for future comparative research and indicate potential opportunities for earlier intervention to prevent trajectories into more serious offending, particularly in young people and those with mental disorder.

A feasibility study on violence prevention in outpatients with schizophrenia.

Patients with schizophrenia have an increased risk of violent behavior, and occupy a large percentage of forensic beds. Most patients in forensic psychiatry have already undergone general psychiatric therapy. This predestinates general psychiatrists to identify those patients presenting such a risk, and to try to intervene so that violence can be prevented. Feasibility study of violence prevention using cognitive-behavioral therapy interventions in male patients with schizophrenia on a general psychiatric ward. Of our patients admitted with schizophrenia, 39.1% had committed violent acts against others; the severity of the act was usually low. The percentage of non-participants was high (83.1%). Study subjects were younger, had not been ill for as long, and were less apt to drop out of the ongoing general psychiatric treatment than the non-participants. Study subjects and non-participants did not differ in the violent act's severity. Our therapy manual proved to be sensible and practical. Those of us attempting to prevent schizophrenic patients from committing violence must deal with individuals who are generally hard to reach. We succeeded in achieving a low drop-out rate after having recruited patients who had displayed a substantial propensity to violence against others.

[Frequency and costs of additional hospitalisations in the year after inpatient or day hospital detoxification treatment]. / Häufigkeit und Kosten zusätzlicher stationärer Behandlungen im Jahr nach tagesklinischer oder vollstationärer Alkoholentzugsbehandlung.

OBJECTIVE: We examined if the presumed reduction in costs of day hospital detoxification compared to inpatient treatment is neutralised by more frequent additional inpatient treatment episodes during a 1-year follow-up. METHOD: Randomised clinical trial with 1-year follow-ups. Calculation of costs for additional treatments is based on data from health insurances. RESULTS: Compared to inpatient treatment, day hospital treatment saved approximately 24 % of the costs of the initial detoxification. Overall, additional inpatient treatments during the follow-up period produced more costs than the initial treatments, but no significant difference emerged between the treatment groups. About 75 % of costs for additional treatments were caused by 25 % of the patients. CONCLUSIONS: Lower costs of day treatment detoxification treatment are not annilihated by increased costs of additional inpatient treatments during the first year after discharge. Under a health services perspective, research concerning a relatively small group of "heavy users" is especially important.

A randomised clinical trial of in-patient versus combined day hospital treatment of alcoholism: primary and secondary outcome measures.

In Germany, the treatment system for alcoholics is predominantly in-patient (IP) oriented, but no randomised trials of setting effects have been conducted until now. We examined if detoxification treatment offered in a day clinic setting would lead to results comparable to the usual IP treatment. After initial IP detoxification, patients (n = 109) at a standard withdrawal treatment unit were randomly assigned to IP or day hospital groups. In both settings, identical psychosocial treatment was given. In this article, results of primary (percent days abstinent and drinks per drinking day) and secondary outcome measures (relapses during treatment, premature termination, additional hospitalisation during follow-up, percent of voluntary abstinent days and continuous abstinence) are reported. Outcome measures were assessed quarterly during a 1-year follow-up period. Patients improved significantly after both treatments, but we found no significant setting or setting x time interaction effects for any primary or secondary outcome measure.