[Treatment Outcome of Migrants and Non-Migrants in Forensic Psychiatry. A Retrospective Case Control Study Using Bavarian Data From 2010 to 2019]. / Behandlungsoutcome von Maßregelpatient:innen mit Migrationshintergrund. Analyse bayerischer Daten zur Qualitätserfassung von 2010 bis 2019.

Objective Analysis of the relationship between patients' migration status and the outcomes of forensic psychiatry in terms of time from entry to discharge and discharge mode.Methods Based on outcome data of the Bavarian forensic psychiatry, a retrospective case-control analysis between migrants and non-migrants was conducted. Participants were matched on age, sex, main diagnosis and main offence.Results Regarding treatment according to Section 63 of the German Criminal Code (Placement in psychiatric hospital), migrant and non-migrants didn't differ significanlty in the observed variables. Regarding treatment according to Section 64 of the German Criminal Code (Placement in addiction treatment facility), migrants' treatment was terminated prematurely more often and after less time than non-migrant's treatment.Conclusion Treatment according to Section 64 of the German Criminal Code is less successful for migrants.

[Self-determination and forensic addiction treatment : Reflections on the tension between patient autonomy and the preventive function of Sect. 64 of the German Criminal Code (StGB) from a psychiatric, ethical and normative perspective]. / Selbstbestimmung und forensische Suchtbehandlung : Reflexionen zum Spannungsfeld zwischen Patientenautonomie und dem Präventionsauftrag des § 64 StGB aus psychiatrischer, ethischer und normativer Sicht.

BACKGROUND: Among the current proposals for the upcoming reform of forensic addiction treatment according to Sect. 64 of the German Criminal Code (StGB), that of the DGPPN stands out as the most far-reaching. Among other things, it calls for making the ordering of the measure dependent on the consent of the defendant and the regular and voluntary demonstration of the willingness to undergo treatment. Prior to treatment in a forensic addiction facility, those affected should reliably participate in addiction-specific treatment offers in the prison setting. AIMS: A critical reflection on the key assumptions and implications of this reform proposal with respect to treatment motivation and the right or ability to self-determination. MATERIAL AND METHODS: These assumptions are analyzed and discussed from psychiatric, medical-ethical and legal-normative perspectives. RESULTS AND DISCUSSION: Neither the setting nor the resources of a prison seem to make it a suitable place for the motivationally critical phases of (probationary) addiction treatment. The approach that only those who have previously demonstrated therapy motivation in word and deed should have the "advantage" of forensic withdrawal therapy, would not do justice to the complexity of substance use disorders and would lead to an overestimation of the already elusive concept of therapy motivation in the context of this disorder. Also, from an ethical perspective, self-determination in forensic addiction patients appears too understudied, both conceptually and empirically, to justify such a far-reaching approach. On a normative level, the new approach would remove an effective special prevention instrument from the hand and create an imbalance in the structure of sanctions.

Comparison of outcome in men and women after treatment in psychiatric security hospitals in Germany.

Previous research has shown that forensic psychiatric treatment reduces reoffending, rehospitalization and premature mortality. Treatment outcome varies with diagnosis, but little is known about the influence of sex, psychosocial adjustment and aftercare. To assess these variables, we interviewed male and female patients discharged from three psychiatric security hospitals in Germany in the years 2010-2017. Participants were interviewed at discharge (n = 609) and 1 year later (n = 366) about reoffending, readmissions, substance use and psychosocial adjustment. Among patients with substance use disorder (SUD), 14% reoffended, 20% were re-hospitalized and 60% maintained abstinence. Among patients with severe mental disorder, 5% reoffended and 13% were re-hospitalized. Significant sex differences were found in offenders with SUD. The results suggest that sociodemographic and disorder-related risk factors are associated with treatment success and that female patients with SUD might need a specific treatment approach. Sex-specific aspects, diagnosis and psychosocial adjustment should be considered in forensic psychiatric treatment and risk assessment.

Criminal Recidivism After Forensic Psychiatric Treatment. A Multicenter Study on the Role of Pretreatment, Treatment-Related, and Follow-Up Variables.

This study examined associations between criminal recidivism after discharge from forensic treatment and variables related to either the time before the current forensic treatment, or the current forensic treatment, or the follow-up after discharge. Participants were treated in 12 forensic clinics according to section 63 of the German penal code. A patient was classified as a criminal recidivist when the patient or the aftercare reported that the patient was delinquent at follow-up. Patients without criminal recidivism were patients for which both perspectives (patient and aftercare) reported no delinquency at follow-up. Mann-Whitney U-tests and Fisher's exact tests were performed. Data to classify patients were available for N = 249 patients. Fifteen patients (6%) were classified as criminal recidivists. The follow-up was M = 12.58 (SD = 1.84) months, and the criminal acts occurred M = 6.00 (SD = 5.55) months after discharge. Differences between patients with and without criminal recidivism were found in pretreatment (young age at first crime, early onset of mental disorder, previous forensic treatments), treatment-related (disorder due to psychoactive substance use, gradual release abuses, outbreaks, assaults against staff, criminal act during treatment, type of discharge, outcome ratings), as well as follow-up variables (no specified housing situation, not being abstinent from psychoactive substances, inpatient readmission, course of outpatient treatment, course of mental disorder) (all p < 0.05). To conclude, it is important to consider variables related to the time before the current treatment, treatment-related variables, and variables related to the follow-up to identify the patients at risk of criminal recidivism after discharge from forensic treatment.

[Who Benefits from Forensic Psychiatric Treatment? Results of a Catamnestic Study in Swabia]. / Wer profitiert von einer Behandlung im Maßregelvollzug? Ergebnisse einer bayernweiten Katamnesestudie für den Bezirk Schwaben.

OBJECTIVE: Evaluation of treatment outcomes of forensic inpatients in the Bavarian district of Swabia (2010 - 2014). METHODS: 130 inpatients were interviewed about their social reintegration, substance use and delinquency immediately after discharge from forensic psychiatry and one year after. RESULTS: One year after discharge 67 % of the patients referred due to substance use disorder according to §â€Š64 of the German Penal Code were employed, 57 % were abstinent and 83 % did not reoffend. Patients who were detained due to severe mental illness according to §â€Š63 of the German Penal Code often received inability pensions (57 %), 14 % were integrated in sheltered workshops and 100 % did not reoffend. CONCLUSION: Forensic-psychiatric treatment contributes to rehabilitation and reduces risk factors of mentally disordered offenders.