Abstract
Background: There is limited international as well as national research on suicide events in prisons and in forensic psychiatric hospitals. This retrospective study compares completed suicide events within these two high-risk populations in state institutions over a time period of 5 years from 2000 to 2004.Material and Methods: Data was collected through a nationwide survey: all forensic psychiatric hospitals within Germany were contacted via postal mail and received a questionnaire concerning the suicide events from 2000 to 2004. All federal lands of Germany were similarly assessed by a survey endorsed by the respective federal ministries of justice. All prison institutions (100%) participated in the survey, while 84% (53 units) of the forensic psychiatric hospitals nationwide contributed. A comparative statistical analysis was conducted using Fisher's exact test or the Mann-Whitney U-test (age). A multivariate logistic regression analysis was done to assess adjusted effects. For the Kaplan-Meier analysis, the months until suicide were analyzed followed by a Cox-regression analysis.Results: There was no statistically significant difference between the mean suicide rate in forensic psychiatric hospitals (123/100.000, 95% confidence interval: [0.00103, 0.00147]) and in the prison system (130/100.000, 95% confidence interval: [0.00109, 0.00154]). Patients who committed suicide in the forensic hospitals were, in comparison to the prison system, more likely to have committed a violent offense and have had a prior history of suicide attempts. The duration from admission into the institution to the suicide event was significantly shorter in the prison group. Also, younger people commited suicide earlier during their stay in a forensic psychiatric hospital or prison.Conclusions: While the results suggest a necessity to optimize data collection in the prison system (prior suicide events and history of mental disorder), it is important to discuss the current discharge arrangements within the forensic hospitals.
Highlights
All European legislations recognize the concept of criminal responsibility as a prerequisite for punishment
The sample consisted of 519 completed suicide events: 479 prison suicides and 40 suicides in forensic psychiatric hospitals
Men committed 99% of the suicides, 23% were of nonGerman nationality, 51% were in an early stage of confinement, and 53% were in prison or in a forensic hospital because of a violent crime
Summary
All European legislations recognize the concept of criminal responsibility as a prerequisite for punishment. Most European countries require some degree of reduced responsibility for the crime committed for entry into the forensic psychiatric system, while offenders with full responsibility can be subject to a prison sentence. In Croatia, Portugal, and Italy, the time of psychiatric detention is limited to the prison sentence the individual would have received without a mental disorder. There is limited international as well as national research on suicide events in prisons and in forensic psychiatric hospitals. This retrospective study compares completed suicide events within these two high-risk populations in state institutions over a time period of 5 years from 2000 to 2004
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