Foreign National Patients in German Prison Psychiatry.

Britta Neumann,Annette Opitz-Welke,Thomas Ross

doi:10.3389/fpsyt.2019.00988

Britta Neumann, Annette Opitz-Welke + Show 1 more

Open Access

https://doi.org/10.3389/fpsyt.2019.00988

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Abstract

IntroductionOver 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.AimsWe 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.MethodFrom 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 χ²-test. The odds ratios for citizenship-related differences in diagnosis and institution of treatment were evaluated by using logistic regression.ResultsMentally 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 hospital psychiatry, but significant citizenship-related differences could not be verified in high-security hospital patients.ConclusionTreatment conditions of foreign national patients in prison psychiatry must be improved. To achieve this, the psychiatric assessment and (mental) health-related aspects of these patients should be further investigated.

Highlights

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
Foreign nationals accounted for 42% of all patients, which is significantly higher than the average of 33.2% foreign nationals in the Berlin penal system and 13.6% in the general population, as reported in the reference period [7, 46]
Compared to German patients, we found that foreign nationals were half as likely to be treated in high-security hospitals rather than in prison hospital psychiatry, after adjusting for diagnosis, age at admission, marital status, and substance abuse

Summary

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. 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. The share of foreign national prisoners has grown at a disproportionately high rate over the past few years. In England and Wales, for example, foreign nationals accounted for approximately 9.4% [1, 2] of the general population and 12% of the overall prison population in 2017 [3]. Van Kalmthout et al [9] stated that foreign nationals accounted for more than 20% of all European prisoners and according to the UNODC Handbook of Prisoners with Special Needs [10] and the World Prison Brief [11] foreign prisoners are significantly overrepresented in some non-Western countries as well

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