Forensic psychiatry is a subspecialty and specialty of psychiatry and psychotherapy. Forensic psychiatry is perceived by the general public primarily through the state-run therapeutic facilities of the Maßregelvollzugs for mentally ill offenders, which exist in every German state. Placement in a forensic facility occurs after a criminal offense at the request of the public prosecutor’s office by court order.
What is forensic psychiatry?
Forensic psychiatry is a special sub-specialty of general psychiatry. Care and evaluation of mentally ill offenders is provided by specially trained forensic psychiatrists. Forensic psychiatry, forensic psychology or forensic psychotherapy, also referred to as forensics for short, is a special sub-specialty of general psychiatry, the care and assessment of mentally ill offenders is carried out by specially trained forensic psychiatrists. The sub-specialty of forensic psychiatry is a specific medical training of a psychiatrist who has already completed his training. However, forensic psychiatry is not a specialty designation. Forensic psychiatry is primarily concerned with the assessment of capital offenses relevant to criminal law as well as the therapy of mentally ill offenders who have committed such offenses. Patients who have committed relevant offenses under the influence of drugs or medication are also assessed and treated by forensic psychiatrists. If a forensic psychiatric report is drawn up, it is primarily a matter of assessing the so-called ability to control or inability to control during the commission of the crime. Lawbreakers who can only be proven to be partially guilty in the course of the assessment can also be placed in the so-called “Maßregelvollzug” of a forensic hospital as outpatients or inpatients. The accommodation can also be carried out compulsorily against the will of a delinquent by judicial order.
Treatments and therapies
The treatment spectrum of forensic psychiatry is strictly oriented to the legal framework. According to § 126a of the Criminal Code, an offender who commits a crime while under the influence of drugs or in the context of a mental disorder may be remanded in forensic custody until the start of the trial. § Section 63 of the German Criminal Code regulates the placement of mentally ill persons in the forensic psychiatric unit if a criminal offense has been committed. In this case, forensic psychiatric therapy cannot be discontinued. § Section 64 of the German Penal Code covers patients who have committed a criminal offense under the influence of drugs; the law makes no distinction as to the type of drug. The guiding principle of treatment is therapy instead of punishment, but this always presupposes the offender’s consent to therapy. If an addict does not want to undergo forensic therapy, then placement under Section 64 takes the form of criminal detention. The paragraph on preventive detention, § 66, also plays a major role in forensics, which can be ordered in the main hearing if the severity of the guilt is particularly serious or particularly serious offenses have been committed repeatedly. According to the supreme court ruling of the Federal Constitutional Court, preventive detention must always be ordered in the main hearing. So-called subsequent preventive detention is no longer possible. Perpetrators who are placed in the Maßregelvollzug have committed their acts either under the influence of drugs or in the context of a psychiatric illness. Forensic psychiatry therefore treats and examines, among others, patients suffering from polytoxicomania or addictions to heroin, cocaine, alcohol or amphetamine. Likewise, all known personality disorders or schizophrenias can lead to committing a crime in a state of reduced culpability. Particularly frequently treated clinical pictures in forensic psychiatry include paranoid schizophrenia, hebephrenia, schizophrenia simplex, and so-called catatonic schizophrenia. Personality disorders relevant to forensic psychiatry include dissocial, schizotypal, borderline, or combined disorders.
Diagnosis and examination methods
For the diagnosis, therapy, and assessment of forensic psychiatric patients, proven methods are available, as they are also used in general psychiatry.Even though the therapy aspect is essential in forensics, the safety aspect is paramount. Employees in forensic psychiatry are always equipped with a personal emergency call system, PNA, which must be worn on the body. In the event of an emergency, nursing staff from neighboring wards can thus provide help quickly. Many forensic psychiatric wards also have their own security service. Central camera surveillance of wards, courtyards or other areas is also typical. Particularly dangerous patients are also permanently monitored by camera in their rooms. In order to be able to provide successful therapy, the nursing staff always try to build up trust with the patients so that therapy is possible at all. Delusions or psychoses of inmates in forensics are very often treated with psychotropic drugs, which have to be taken several times a day under the supervision of nursing staff. Separate generations and modifications of psychotropic drugs have already been developed for the targeted therapy of mentally ill offenders. These are always prescription preparations that may only be dispensed by pharmacies under certain conditions and in compliance with special medical guidelines. Various forms of psychotherapy also play an important role in the daily routine of forensic wards. Proven psychotherapeutic models in forensics include occupational therapy, milieu therapy, and patient participation in social skills groups. Forensic psychiatrists often use psychoeducation as a method of exploration in order to understand an offender’s background and curriculum vitae and to explore the origins of the crime in depth psychology. This psychotherapeutic procedure is understood as diagnosis and therapy at the same time and comprises at least 15 sessions. Depending on the clinical picture and the length of a patient’s stay, usually several years or lifelong, psychoeducation may also extend as an accompanying measure throughout the entire period of imprisonment.
