[Violence by and against people with mental illnesses]

[The situation in the German forensic commitment-Results of a survey by the DGPPN]

BACKGROUND AND OBJECTIVE

In German forensic psychiatry detention under Sections 63 and 64 of the German Penal Code have been repeatedly reformed over the past years; however, despite the most recent amendments to the law on detention, clinics and state authorities warn of insufficient capacities and worrying conditions. Media reports paint a defiant picture. At the same time, there is a lack of valid data that would allow an objective description of the situation in forensic psychiatry. Against this background the management of institutions in Germany has been surveyed.

MATERIAL AND METHODS

The survey was conducted as an online survey and sent to all 78 forensic hospitals in Germany. The survey covered topics such as structural data of the facilities, the occupancy and staffing situation, incidents, support from supervisory authorities and funding agencies, and patient characteristics. The results are presented descriptively.

RESULTS

Of the 78 facilities contacted, 45 (approximately 60%) participated at least partially in the survey. Many of the clinics (68.5%) complained of significant overcrowding. A clear lack of staff and rooms was reported, at the same time it was stated that patients do not receive adequate treatment. Approximately 1 in 5 patients have a length of stay for more than 10 years and one third of the clinics reported an increasing number of physical assaults by patients.

CONCLUSION

This overview shows that the forensic psychiatric hospitals are in very different but generally strained situations. A significant number of clinics are under great pressure. Financial, structural, spatial and personnel resources were described as insufficient to properly and professionally fulfill the legal mandate. The treatment standards presented by the DGPPN in 2017 are not met in many clinics.

Status of mandatory treatment of mentally ill offenders without criminal responsibility in China: Information from 5,262 mandatory treatment judgments

Background

To avoid public health risks, all governments ensure monitoring and treatment of mentally ill persons if they offend and assess their level of criminal responsibility. The Criminal Procedure Law of the People's Republic of China (2013) instituted special procedures. However, there are few articles in English which explain the implementation of mandatory treatment procedures in China.

Methods

We collected 5,262 qualified documents from 2013 to 2021 from the China Judgments Documents Online. We analyzed social demographic characteristics, trial-related information as well as the mandatory treatment-related content, to investigate the mandatory treatment of China's mentally ill offenders without criminal responsibility, from 2013 to 2021. Simple descriptive statistics and chi-square tests were used to compare differences among several types of documents.

Results

There was an overall change trend of the number of documents: increasing year by year from 2013 to 2019 after the implementation of the new law, but with sharp decrease in 2020 and 2021 during covid-19 pandemic. From 2013 to 2021, a total of 3,854 people had applications made for mandatory treatment, of whom 3,747 (97.2%) were given mandatory treatment, 107 (2.8%) had applications rejected. "Schizophrenia and other psychotic disorders" was the most common diagnosis in both groups and all offenders receiving mandatory treatment (3,747, 100.0%) were considered to have no criminal responsibility. A total of 1,294 patients had applications made for relief of mandatory treatment, of whom 827 (63.9%) were subsequently approved for relief, 467 (36.1%) were rejected. A total of 118 patients had applications for relief two or more times, and 56 (47.5%) were finally relieved.

Conclusion

Our study presents the Chinese model of a criminal mandatory treatment system to the international community which has been in operation since the implementation of the new law. Legislatory changes and covid-19 pandemic can have effect on the number of mandatory treatment cases. Patients, their close relatives and mandatory treatment institutions have the right to apply for relief from mandatory treatment, but the final decision in China is taken by the court.

Reconsidering the ethics of compulsive treatment in light of clinical psychiatry: A selective review of literature

The ethics of compulsive treatment (CT) is a medical, social and legal discussion that reemerged after the ratification by 181 countries of the 2007 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). The optional protocol of the UN-CRPD was ratified by 86 countries aiming to promote, protect and ensure the full and equal enjoyment of all human rights. It also determined the need to review mental health laws as under this light treatment of persons with disabilities, particularly those with mental disorders, cannot accept the use of CT. This selective review of literature aims to clarify inputs from clinical psychiatry adding evidence to the multi-disciplinary discussion. It provides contradictory evidence on how patients experience CT and its impact on their mental health and treatment programs, also which are main reasons for the use of CT and what efforts in psychiatry have been made to reduce, replace and refine it.

Reconsidering the ethics of compulsive treatment under the light of clinical psychiatry

The ethics of compulsive treatment (CT) is a medical, social and legal discussion that reemerged after the ratification by 181 countries of the 2007 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). The optional protocol of the UN-CRPD was ratified by 86 countries aiming to promote, protect and ensure the full and equal enjoyment of all human rights. It also determined the need to review mental health laws as under this light treatment of persons with disabilities, particularly those with mental disorders, cannot accept the use of CT. This selective review of literature aims to clarify inputs from clinical psychiatry adding evidence to the multi-disciplinary discussion. It focuses on how patients experience CT and its impact on their mental health and treatment programs, the reasons for the use of CT versus voluntary treatment and what efforts have been made to reduce, replace and refine the presence of CT in psychiatry.

Reconsidering the ethics of compulsive treatment in light of clinical psychiatry: A selective review of literature

The ethics of compulsive treatment (CT) is a medical, social and legal discussion that reemerged after the ratification by 181 countries of the 2007 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). The optional protocol of the UN-CRPD was ratified by 86 countries aiming to promote, protect and ensure the full and equal enjoyment of all human rights. It also determined the need to review mental health laws as under this light treatment of persons with disabilities, particularly those with mental disorders, cannot accept the use of CT. This selective review of literature aims to clarify inputs from clinical psychiatry adding evidence to the multi-disciplinary discussion. It provides contradictory evidence on how patients experience CT and its impact on their mental health and treatment programs, also which are main reasons for the use of CT and what efforts in psychiatry have been made to reduce, replace and refine it.

Kurze Zündschnur: Ärger – Wut – Aggression

Verschiedene psychische Erkrankungen, wie Persönlichkeitsstörungen, sind mit einem Risiko für gewalttätiges Verhalten assoziiert. Dieses Risiko wird jedoch nur selten durch gezielte psychotherapeutische Interventionen adressiert. Vielmehr werden im psychiatrischen Setting aggressive und impulsive Patienten oftmals isoliert und auf geschützten Stationen aufgenommen. Dies kann beispielsweise durch Stigmatisierung und das Schüren von Ängsten aggressives Verhalten auch begünstigen. Aufgrund von aggressivem Verhalten kommt es zudem häufig zu kurzfristigen disziplinarischen Entlassungen oder konflikthaften Eskalationen im Stationsalltag. Insgesamt besteht sowohl im stationären als auch im ambulanten Setting eine Versorgungslücke. Es mangelt an spezifischen psychotherapeutischen Angeboten, die Patienten Strategien zur Bewältigung von aggressivem Verhalten vermitteln können.

Ein Patientenkollektiv, an dem diese Versorgungslücke deutlich wird, sind Männer mit Persönlichkeitsstörungen. Speziell für diese Patienten wurde ein gruppenpsychotherapeutisches Konzept entwickelt, welches hier vorgestellt werden soll: Die Ärger-Wut-Aggressions(AeWA)-Gruppe. Das Konzept nimmt männliche Patienten mit Störung der Impulskontrolle in den Blick. Dabei wird auf emotionale und entwicklungspsychologische Kernbedürfnisse eingegangen und eine Vielzahl an kognitiven, behavioralen und emotionsfokussierten Techniken vermittelt. Diese sollen eine funktionale Emotionsregulation fördern und gleichzeitig das Auftreten von aggressiven Verhaltensweisen und das damit verbundene Risiko für Straffälligkeit verringern.

[A Police Perspective on the Interaction with Individuals with Mental Disorders]

OBJECTIVE

Police officers often come in contact with individuals suffering from behavior disturbances. The present study examined the subjective experience of these interactions from a police perspective to detect further needs in police trainings to make these interactions safer.

METHODS

N = 958 police officers filled out a questionnaire regarding their subjective experience. The questionnaire assessed the frequency of contact with individuals with behavior disturbances, specific challenges in regard to the interaction and associated subjective anxiety or stress as well as knowledge about behavior disturbances.

RESULTS

Police staff experience individuals suffering from behavior disturbances often as unpredictable, verbally and physically aggressive. 27.9 % report anxiety in these interactions and 76 % report a lack of specific knowledge.

CONCLUSION

Police training programs should focus on increasing mental health literacy, specific communication skills and anti-stigma interventions.