Inpatient treatment in the psychiatric department of a German prison hospital.

OBJECTIVE: Although the construct of psychic incompetence can prevent severely mentally disturbed persons from being imprisoned in Germany, the prevalence of mentally disordered persons who are detained is high. Data describing the characteristics of mentally disturbed detainees in Germany are scarce. The following study uses data from a psychiatric care institution in a prison to examine the distribution of psychiatric diagnoses in relation to age, nationality and legal status. The distribution of diagnoses is compared to that of the psychiatric department at a Berlin community hospital.
METHOD: The data were recorded during each patient's hospital treatment and summarised on the day of discharge. The following variables were assessed: age, length of stay in days, main diagnosis, up to 2 additional diagnoses, frequency of violent or suicidal behaviour, and nationality. Data were collected from January 2010 to February 2011 in the psychiatric department of the Berlin Prison Hospital.
RESULTS: During a 14-month period, 107 patients were discharged from psychiatric inpatient care and N=124 completed treatments were observed. Of these patients, 21.5% were pre-trial detainees, and 58% were of German nationality. The mean age was 37.7 years. Non-German patients were younger than German patients. Fifty-five percent of the patients suffered from a psychotic disorder, and 7.5% had a main diagnosis of antisocial personality disorder. Personality disorders were significantly less frequently diagnosed in non-German patients. An additional diagnosis of substance abuse was present in 66% of the patients, and 17.8% of the patients showed suicidal and/or violent behaviour or had to be restrained (immobilisation, isolation, compulsory medication). The frequency of suicide, violence and compulsory measures did not differ significantly between German and non-German patients, between younger and older patients or between remand and sentenced inmates. The distribution of psychiatric diagnoses was similar to that of a Berlin community hospital.
CONCLUSIONS: Personality disorders were more frequently diagnosed in German than in non-German patients. The burden of personality disorders among mentally ill prison detainees in Berlin Prison Hospital was not significantly higher than that of a Berlin community hospital. The percentage of non-German patients in the psychiatric department of the Berlin Prison Hospital was more than two times higher than in a psychiatric department of a community hospital. The lower-than-expected rate of suicide attempts among pre-trial detainees may be an indicator of a beneficial effect of the treatment setting in the psychiatric department of Berlin Prison Hospital.