Standards and open problems in psychiatric forensic commitment Comments on the DGPPN standards for treatment in forensic commitment

The "Standards for treatment in forensic commitment according to 63 and 64 StGB" (German Penal Code) compiled by a working group of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) are a solid description of important aspects of forensic commitment, which are suitable for instruction of ministerial bureaucracy, politicians and journalists, if nothing else in order to reassure them. Forensic commitment is a well-organized, to a great extent legally clearly defined measure to reduce the risk of recidivism in mentally ill or disturbed offenders on a scientific foundation. Forensic commitment achieves security and accordingly also makes efforts to consider the needs of the patients; however, further standards would be desirable for personnel of the forensic commitment, which involves the know-how of treatment. How can the lengthy term of commitment be reduced? How can the treatment stages be organized? Is there a unified criminal therapy or is there still a deficiency in forensically adapted forms of treatment? All the problems that arise from imprisonment and powerlessness of patients are barely covered in the standards, which fundamentally differentiates forensic commitment as a substitute punishment from general psychiatry. How do we deal with refusal of (psycho) therapy, occasional substance abuse, rebellious behavior and general violations of rules? Is the staged system antiquated? Should individual criminal prognoses be abandoned in the future? How can the qualifications of junior staff who work closely with the patients be guaranteed? The presentation of ethical problems in the "standards" are taken up and critically dscussed and various problem zones that need further discussion and solutions are outlined.