Intelligenzgeminderte Rechtsbrecher im Maßregelvollzug

Forensic patients with intellectual disabilities have so far received little attention which is reflected in the comparatively briefly written chapters in the standard textbooks and also the low scientific interest in this patient group. There are only few therapeutic concepts and even less information on their effectiveness. This article presents the Christophorus Clinic in Münster which was the first forensic institution in Germany to specialize in these patients. The institution incorporates 54 treatment places and started operating on 3 June 2011. In addition to the known fact that a therapy concept must (further) develop over the years, during the first year of operation some aspects have arisen which have cristallized as problem areas specific for this patient group, which are discussed.     

Autonomie und Fürsorge im Ma?regelvollzug

In the debate on compulsory treatment of psychiatric patients (Zwangsbehandlung), an excessive emphasis has recently been placed on patient??s rights to self-determination, leading to a series of verdicts which have progressively restricted this type of intervention. Rulings by the Federal Constitutional Court of Germany (Bundesverfassungsgericht) during the previous year have now caught up with involuntary treatment (Ma?regelvollzug). In this paper, an analysis is given of the ethical consequences arising from the conflict between the right to self-determination and medical care at psychiatric clinics. Categorically ruling out compulsory treatment on the basis of the right to self-determination becomes ethically questionable if, due to a misunderstanding of this right, patients are not given appropriate medical care and are thus at risk of neglect, social decline and delinquency, possibly even of endangering third parties.     

Die Durchführung antiandrogener Behandlung von Sexualstraftätern im Berliner Maßregelvollzug

In 2002, the Forensic Psychiatric Hospital in Berlin started a pilot project for combined treatment of sex-offenders with anti-androgenic LH-RH agonists and psychotherapy. On the basis of experience-based knowledge transfer and with almost six years of practical experience, this article reports results of this new approach of combined psychotherapy and drug treatment from medical and psychological viewpoints. First, a short history and general information about the combined treatment are provided. Secondly, its effects on patients’ sexual self-perception, personality disorders and aspects of prognosis are explored. Thirdly, a medical therapy scheme, possible side effects, as well as issues of patients’ rights and approvals are discussed.     

Drogenabhängige Patienten im Maßregelvollzug gemäß § 64 StGB: Verbesserung der Quote erfolgreicher Behandlung durch suchtspezifische Medikation?

In Germany, addicted offenders can be sentenced to compulsory addiction treatment in forensic mental hospital departments (Art. 64 of the penal code). A presupposition to such a sentence is a fair chance of successful treatment and rehabilitation. Commonly, an expert witness is asked by the court to assess this point in the trial. To date, the treatment in forensic mental hospitals aims at total abstinence from any kind of drugs. But in at least half of the cases, a fair chance of successful treatment is no longer seen after a period of therapy. In most cases, these patients are returned to prison. The paper pleads that in offenders addicted to illegal drugs, a drug specific medication – in particular methadone maintenance treatment or naltrexone medication – might be a useful option. The rate of “treatment failure” might be reduced slightly by using this option with some of the patients.     

Zur Differenzierung zwischen unsicheren und aggressiven Teilnehmern beim Gruppentraining Sozialer Kompetenzen (GSK) im Straf- und Maßregelvollzug

The cognitive-behavioural group training for social competence “GSK” [16] has proven to also be effective in the penal system [28]. The present study examines if a targeted differentiating assessment prior to the intervention and a thereon based homogeneous group composition with regard to insecure and aggressive behaviour patterns can enhance the effectiveness of the “GSK” in the penal system and in a forensic hospital unit. Altogether 48 male delinquents across both settings were therefore divided into a “homogeneous insecure” group, a “homogeneous aggressive” group and a “heterogeneous” group. Pre-post-comparisons show that the intervention is effective for all three groups and also in both settings, the penal system and the forensic hospital unit. The “homogeneous aggressive” group revealed the strongest intervention effects.     

Können Patienten aus dem Maßregelvollzug (§ 64 StGB) resozialisiert werden?

In the Regensburg follow-up study pre-inpatient and post-inpatient clinical courses are delineated and predictors for successful completion of therapy have been extracted and feed-back of examinees was also taken into consideration (n?=?662). The catamnestic interval was a minimal of 1 year and the response rate was 81%. Of the addicts 65% have consistently been abstinent since their release. Recidivism was prevented in 81% whereby all chargeable conducts were analyzed independent of the actual criminal prosecution. – If social integration was accomplished in former § 64 StGB patients and if they were satisfied with the targets achieved, this was considered to have had a positive effect. A specialized follow-up also proved to have protective potential.     

Economic Hardship, Neighborhood Context, and Parenting: Prospective Effects on Mexican�CAmerican Adolescent��s Mental Health

This study examined family and neighborhood influences relevant to low-income status to determine how they combine to predict the parenting behaviors of Mexican-American mothers and fathers. The study also examined the role of parenting as a mediator of these contextual influences on adolescent internalizing and externalizing symptoms. Study hypotheses were examined in a diverse sample of Mexican-American families in which 750 mothers and 467 fathers reported on their own levels of parental warmth and harsh parenting. Family economic hardship, neighborhood familism values, and neighborhood risk indicators were all uniquely associated with maternal and paternal warmth, and maternal warmth mediated the effects of these contextual influences on adolescent externalizing symptoms in prospective analyses. Parents' subjective perceptions of neighborhood danger interacted with objective indicators of neighborhood disadvantage to influence maternal and paternal warmth. Neighborhood familism values had unique direct effects on adolescent externalizing symptoms in prospective analyses, after accounting for all other context and parenting effects.