[Revision of §64 of the German Penal Code from a psychiatric perspective-Position paper of a task force of the German Association for Psychiatry, Psychotherapy and Psychosomatics]. / Neuregelung des § 64 StGB aus psychiatrischer Sicht ­ Positionspapier einer Task-Force der DGPPN.

In Germany every second offence occasioning bodily harm and every fourth sexual offence occur under the influence of alcohol or drugs. Untreated substance use disorders are a risk factor for further offences. The §64 of the German Penal Code (StGB) regulates the commitment of offenders to a Forensic addiction treatment unit as a result of an addiction to excessive consummation of intoxicating substances. The previous regulation has come under criticism because too many patients are committed, the sentence is often given to the wrong persons, the treatment is often terminated without success and the sentence consumes to many resources. From a psychiatric perspective the reform of commitment to a Forensic addiction treatment unit (§64 StGB) must fulfil the principles of medical ethics, in particular the respect for the autonomy of the patient, the principle of distributional justice and the code of medical professional ethics. The commitment according to §64 must be restricted to the treatment of people with a clinically relevant substance use disorder. From a psychiatric perspective, decisive for the prospect of success are the willingness to be treated and self-determination for admission to the clinic. In order to release the treatment from the extrinsic influences of the enforcement law, on admission to treatment a sufficient amount of the sentence should have already been served that the commitment only serves the purpose of the treatment and resocialization, so that the risk of further substance-related offences is reduced. The legal term "Entziehungsanstalt" should be replaced by "Forensic Clinic for Dependancy Diseases".

[Case Report about an Inpatient Suicide by Asphyxia without Strangulation]. / Fallbericht über einen Kliniksuizid durch Asphyxie ohne Strangulation.

A risk of suicide in the course of a psychiatric disorder will often be answered with an admission for inpatient psychiatric treatment, resulting in a high potential of suicidal behavior on the ward. Despite extensive safety precautions and therapeutic interventions, suicides still occur within psychiatric hospitals. Such incidents, known as inpatient suicides, are rare but significant, necessitating further examination. We present the case of a 91-year-old suicidal male patient, who committed suicide on an open ward on a Sunday morning by blocking his nostrils with cotton and tissue and breathing into a pillow, leading to death by asphyxia. The case report aims to draw attention to the possibility of this extraordinary method of suicide, demonstrating that a suicide can be accomplished in a psychiatric hospital even without the use of prohibited dangerous objects.

Institutions and services of psychiatric care in Saxony-Anhalt: assessment with the European Services Mapping Schedule.

This article describes and analyses the availability of outpatient, inpatient and community-based psychiatric care in Saxony-Anhalt, one of the federal states in the eastern part of Germany. The European Services Mapping Schedule was used to classify 365 institutions. Outpatient care was provided by an average of four private practice psychiatrists per 100,000 inhabitants, which is low when compared to the German average. Ten secure beds (forensic), 48 acute beds, 13 elective beds and 13 day hospital places per 100,000 inhabitants were available for inpatient care. Non-acute non-hospital residential services with indefinite stay and with 24 h support amounted to 240 places per 100,000, with regional differences ranging from less than 100 to more than 1000. Other facilities offering paid work or work-related activities were scarce and some services providing structured activity or social contact were available only in urban agglomerations. Overall, psychiatric care in Saxony-Anhalt is fragmented as regards providers and funding.