Foreign National Patients in German Prison Psychiatry

Abstract

Introduction: Over the past few years, the share of foreign national prisoners in the European and American justice systems has increased at a disproportionately high rate, yet studies on mental health issues among this diverse group are rare. Recent research suggests a range of factors leading to mental health vulnerability in foreign national prisoners, including language barriers, isolation, cultural misunderstanding, and legal standing. Relevant findings of topic-related studies indicate that under-referral to mental health services due to missed or misinterpreted symptoms is a major risk for foreign national prisoners. Aims: We aimed to investigate the disparities regarding the percentage of foreign national patients who were treated in high-security hospitals compared to the psychiatric ward of prison hospitals-after adjusting for diagnosis, age, marital status, and substance abuse. We hypothesized that foreign national patients were underrepresented in compulsory, high-security mental health care. We also aimed to explore citizenship-related institutional disparities concerning diagnoses and self-harmful behavior. Method: From 2010 to 2015, data collected from high-security hospitals in the federal state of Baden-Wurttemberg and the psychiatric ward of a Berlin prison hospital was evaluated by comparing nationality, diagnosis, and self-harm using Fisher's exact test and c²-test. The odds ratios for citizenship-related differences in diagnosis and institution of treatment were evaluated by using logistic regression. Results: Mentally ill foreign national patients were significantly less likely to be treated in high-security hospitals rather than prison hospital psychiatry (adjusted for diagnosis, age at admission, marital status, and substance abuse; adjusted OR = 0.5). Foreign nationals and Germans in prison hospital psychiatry showed no significant disparities in diagnosis; however, in high-security hospitals, foreign nationals were more likely to have been diagnosed with schizophrenia/psychotic or neurotic/stress-related disorders and were less likely to have been diagnosed with personality disorders than German patients. Additionally, foreign nationals were more likely to commit self-harm than Germans in

Prison inmates with court-ordered treatments: are they really different?

“…The first concerns criminally responsible offenders that receive the requisite psychiatric treatment via psychiatric consultations on a voluntary basis [ 3 – 5 ]. When needed, inpatient mental health care for this population may be provided via voluntary or compulsory admission to psychiatric hospitals [ 6 , 7 ] or, more rarely, in prison psychiatric wards [ 8 ]. The second refers to offenders with decreased responsibility or high risk of recidivism due to long-lasting mental disorders identified via psychiatric expert witness.…”

“…The second refers to offenders with decreased responsibility or high risk of recidivism due to long-lasting mental disorders identified via psychiatric expert witness. This population may be compulsory admitted to psychiatry care instead of an ordinary sequence under court-ordered treatments (COT) that take place in outpatient facilities or in high and medium-security hospitals [ 8 – 10 ]. These hospitals may be or not located in prison, are usually, but not consistently, funded by the health system and did not depend on the penitentiary system.…”

Mandatory substance use treatment for justice-involved persons in Germany: a systematic review of reoffending, treatment and the recurrence of substance use outcomes

“…Ross et al ( 71 ) note that forensic patients with a migration background in Germany face a range of factors that complicate their health and social needs, including socioeconomic status, racism, access to education, fleeing from war or persecution, factors linked to precarious travel from home countries, and the cultural and linguistic adaptations to life in Germany. These factors are linked to challenges in assessment and treatment engagement ( 72 ). It should be noted that Kemper ( 52 ) found no significant link between either nationality or language difficulties and treatment outcome, however.…”

Psychosis in German prisoners: Comparison of the clinical appearance of psychotic disorder of an imprisoned population with a not detained community group

“…Less severe psychotic symptoms means lower severity of the disease, which might seem less mentally ill or “abnormal” to others. This could also affect the outcome of a trial: Neumann et al (2020) pointed out that, in Germany, referrals to forensic hospitals care are based on a psychiatric examination that was carried out during the prosecution of a serious crime. The treatment setting of patients requiring intensive treatment is therefore primarily bound to the outcome of the court procedure.…”

“…In 2018, there were 50,957 prisoners in Germany, including 2,931 women (Federal Statistical Office [Statistisches Bundesamt], 2018a); the total German population was 83,000,000. In increasingly multicultural societies, the share of foreign national prisoners has grown at a disproportionately high rate over the past few years; in Germany, 11.6% of the general population and 30.1% of prisoners were foreign nationals in 2017 (Neumann, Ross, & Opitz‐Welke, 2020). Neumann and colleagues pointed out that multiple sources indicate serious mental health issues among ethnic‐minority and immigrant prisoners, and according to recent research vulnerability among prisoners, such as language barriers, isolation, cultural misunderstanding, and legal standing, are even more salient for foreign national prisoners (Neumann et al, 2020).…”