Punishing the disoriented? Medical and criminological implications of incarcerating patients with mental disorders for failing to pay a fine

Abstract

According to the German penal code, offenders can basically be sanctioned to a prison sentence or (in cases of misdemeanours) to a fine. If an offender is sentenced to a fine, but is not able or willing to make the payment, then the German state can administer a custodial sentence as a replacement. This is called an ''Ersatzfreiheitsstrafe'' (EFS). The proportion of EFS prisoners accounts for 10% of the German prison population and thus appears to be strikingly high considering the consequences of an imprisonment for the detainee. It has been considered that this is due to high levels of mental disorders in the population of EFS prisoners. This article thus aims at delineating the prevalence of mental disorders in EFS prisoners according to socio-demographic data and ICD-10 diagnoses of two recent German studies. Results of these studies indicate that EFS prisoners indeed are for the most part socially and economically deprived and show a high prevalence of mental disorders. It is argued that their resulting lack of social competence may lead to incapability of avoiding their fee being converted into a prison sentence. As a consequence EFSs have to be seen as supporting social stigmatization and risking a further exclusion from society.

Yield and Efficiency of Mental Disorder Screening at Intake to Prison: A Comparison of DIA-X Short- and Long-Screening-Protocols in Compensation Prisoners

“…The average lifetime prevalence of alcohol-related mental illnesses in compensation prisoners ranges around 75% ( 18 , 19 ), while Germany's general population shows a lifetime prevalence of 3–5% ( 22 – 26 ). For schizophrenia, the estimated lifetime prevalence for compensation prisoners was 4% ( 18 ), while in the German general population a lifetime prevalence of only 1.25% was observed ( 27 ). Similarly, dysthymia has been observed much more frequently in compensation prisoners ( 17 , 18 ) than in the general population ( 28 ).…”

“…For schizophrenia, the estimated lifetime prevalence for compensation prisoners was 4% ( 18 ), while in the German general population a lifetime prevalence of only 1.25% was observed ( 27 ). Similarly, dysthymia has been observed much more frequently in compensation prisoners ( 17 , 18 ) than in the general population ( 28 ). The lifetime prevalence of bipolar disorder in the general population was also 0.5–5.0% ( 29 ), which was significantly lower than that of compensation prisoners ( 17 – 19 ).…”

Criminalization Through Transinstitutionalization: A Critical Review of the Penrose Hypothesis in the Context of Compensation Imprisonment

“…The process of data acquisition and diagnosis of mental disorders was described before ( 25 ). In total, four study populations of randomly selected compensation prisoners were collected in the years 1999 ( 26 ), 2004 ( 27 ), 2010 and 2017 ( 25 ). As all study participants were diagnosed with the same diagnostic system DIA-X, the data were pooled for inferring the prevalence of diverse mental disorders in compensation prisoners.…”