Project

Discipline

indefinite sentencing; Forensic Psychiatry; Criminology; Ageing; Prison; Mental Health Management; Mental health; Medical ethics ; Cost benefit analysis; Human rights

Lead
Älter werden in Haft Teil II: Psychische Gesundheitsversorgung und forensische Evaluierung von älteren und in Verwahrung befindlichen Gefängnisinsassen in der SchweizProf. Dr. med. dipl. theol. Bernice S. Elger (Bioethics and health law, Univ. of Basel and Geneva)Prof. Dr. med. Elmar Habermeyer (Forensic psychiatry, Univ. of Zurich)Prof. Dr. med. Christophe Büla (Geriatrics, Univ. of Lausanne) Prof. Dr. jur. Grischa Merkel (Criminal law, Univ. of Basel)Prof. Dr. jur. Marcelo F. Aebi (Criminology and law, Univ. of Lausanne) Prof. Dr. phil. Alberto Holly (Economics, Univ. of Lausanne)PD Dr. phil. habil. Andreas Mokros, (Forensic psychology, Univ. Hospital of Zurich)
Lay summary
Einleitung Im Projekt CR13I1_135035 (im Folgenden: Agequake-1) beschäftigten sich Experten der Universitäten Basel, Lausanne und Zürich mit der weltweit steigenden Zahl älterer Gefängnisinsassen („Agequake“), insbesondere mit Fragen der Gesundheitsfürsorge, mit den sozialen Auswirkungen und Menschenrechten. In Agequake-1 wurden einzigartige Daten aus den Medizinakten der Häftlinge gesammelt. Der Fokus lag auf körperlichen Erkrankungen, da infolge komplexer Organisation vieler Gesundheitsdienste in den Gefängnissen psychiatrische Erkrankungen schwer zugänglich waren. Inhalt und Ziel des Forschungsprojektes Das Ziel dieses Folgeprojektes ist es darum, die psychische Gesundheit von Gefängnisinsassen zu untersuchen. Das erste Projekt zeigte, dass das Phänomen Agequake in den Gefängnissen nicht zuletzt durch massiv gestiegene Zahlen in Verwahrung befindlicher Häftlinge gespeist wird (Art. 59 und 64, StGB). Die Behandlung dieser Häftlinge sollte u.a. durch forensische Psychiater beaufsichtigt werden. Deren Einschätzung der zukünftigen Risiken, die vom Häftling ausgehen, bildet die Grundlage für Entscheidungen über Entlassungen durch die Justiz. Gegenwärtig gibt es keine systematische Datenerhebung zur psychischen Gesundheit der Häftlinge, zur Qualität der forensischen Einschätzungen sowie dazu, wie die Gesundheitsfürsorge tatsächlich aussieht. Eingedenk dessen wird Agequake-2 zur national wie international dringend benötigten Forschung zur psychischen Gesundheit zweier überlappender Personengruppen beitragen: ältere Gefängnisinsassen (50 Jahre und älter) sowie Personen in Verwahrung. Letztere stellen einen bedeutenden Teil der zukünftigen älteren Häftlinge dar. Unsere Studie wird qualitative und quantitative Methoden verwenden und auf diese Weise wichtige, bisher fehlende Fakten und Daten liefern. Dadurch kann ein signifikanter Beitrag für die zukünftige Organisation in Gefängnissen und diesbezügliche ökonomische Erwägungen geleistet werden.

Direct link to Lay Summary

Last update: 02.01.2017

Active participation

Number	Title	Start	Funding scheme

In the project CR13I1_135035 (hereafter Agequake-1), a group of experts from the Univ. of Basel, Lausanne and Zurich (and well-known national and international advisors) collaborated in a highly efficient and outstandingly productive way in research relating to health care, social implications, and human rights aspects resulting from the considerable increase of aging prisoners worldwide (“agequake”). The research team established extremely valuable contacts and collaborations with Swiss prisons and collected unique retrospective data from medical records of aging prisoners in Switzerland. The focus was on somatic diseases due to the complex organisation and priorities of most prison health care services. Psychiatric care is often provided by separate teams and psychiatric records are not stored in the prison, but in varying external institutions. The aim of this follow-up project is to fill the research gaps concerning (1) prisoners mental health (MH) and (2) evaluate MH prospectively. Indeed, our first project highlighted that the agequake in prisons is fuelled by massive increase in persons sentenced to security measures (art. 59 and 64 CP, Swiss penal code). These detainees should receive treatment under the supervision of MH care personnel, including forensic psychiatrists (FP). Their assessments of detainee’s future risk (“dangerousness”) inform release decisions of the justice system. At present, no systematic data collection exists about the MH problems and the quality of forensic evaluation, as well as how care is provided to these detained patients. Worldwide, research on MH of aging prisoners is still extremely scarce. Agequake-2 will therefore contribute nationally and internationally much needed research on the mental illnesses and cost burden of two overlapping patient groups: aging prisoners (50+ years) and persons Sentenced to Security Measures (SSecM). This latter group will form an important part of the future agequake in prisons. Thus, evaluation of their health care burden and chances to be released is important for future management and economic considerations. Our new dataset is crucial to enable evidence- based forensic evaluation, MH care, and policy, and to make recommendations in different areas: a) quality and outcome of MH care and FP risk (“dangerousness”) assessment, b) social, criminological and economic issues (cost-benefit- analysis, CBA), as well as c) legislative, human rights law and ethics. The project aims at gathering data on an important emerging and increasingly urgent issue. It will examine practical solutions and policy options concerning the conditions under which society in Switzerland may solve issues regarding aging prisoners’ psychiatric care and dangerousness assessments in ways that are economically sound, but at the same time ethically acceptable and in line with international human rights law. The project will unfold in several steps:1.STATE OF THE ART: The started literature review on MH care for aging prisoners, court-ordered forensic treatments for SSecM patients, as well as forensic risk assessments, will be completed. The aim is to understand the management of aging and SSecM prisoners in Switzerland and two countries (Canada, Netherlands) that have internationally recognized good quality structures for forensic care. Research questions are: (a) How is the mental health situation of aging prisoners as well as of SSecM patients? (b) What forensic psychiatric/psychological approaches are used to deal with those challenges in these three countries? (c) What is known about alternative management strategies, their costs and outcome, as well as ethical and legal consequences?2.DATA COLLECTION ON THE MENTAL HEALTH OF AGING PRISONERS AND PERSONS SENTENCED TO SECURITY MEASURES (SSECM) IN SWITZERLAND: Established contacts with prisons and forensic colleagues will be used in the cantons of VD, ZH, AR, FR, VS and BE (where most larger prisons are situated), covering thus the majority of eligible aging prisoners as well as SSecM patients in German and French speaking parts of Switzerland. A prospective screening (Prime-MD, FS-12), diagnostic assessment (MINI), and quality evaluation (HoNOS, already part of obligatory quality control in forensic hospitals) will be carried out during one year (Jan-Dec 2017), complemented by a HoNOS follow up after one year or at release. Medical records of all aging prisoners identified as suffering from MH problems and of all SSecM patients will be studied. The data will be used to describe MH and evaluation related problems of aging and SSecM detainees and management solutions used in the different cantons. We will analyse (a) MH diagnosis, dangerousness assessment, medication and management data, and social problems as far as available in the records; (b) costs (CBA) of different management choices, e.g. treatment in prison vs. specific forensic or hospital wards, and of the care of SSecM patients under the age of 50 in comparison to the 50+ group. To gain an in depth view on imprisonment and management solutions, (c) a sample of 30 to 40 detainees (15-20 from each group: 50+ detainees with significant MH problems and SSecM patients) will, after informed consent, be interviewed.3.EXPERT SURVEY: Results from part 1 and 2 will be contrasted with expert views. The major issues identified in parts 1 and 2 will be taken up in the development of a semi-directive interview guide which will also solicit interviewees’ comments on the practice in their country/canton. Interviews will be held with 45-50 prison and forensic MH care experts, 20 from Switzerland and 12-15 from the above identified two countries. The aim is to capture their opinion about how aging and SSecM prisoners should best be managed by prison systems. The inclusion of international experts is useful to evaluate which strategies could prove useful for Switzerland.4.SOLUTIONS, RECOMMENDATIONS AND DISSEMINATION: Based on the analysis of data resulting from parts 1-3, the final report will include general recommendations, as well as suggestions of urgent measures to be taken to face the present and anticipated challenges. Final steps will include the dissemination of the study results to policy makers and concerned constituencies (correctional institutions, researchers and the public) via scientific publications and conference presentations, as well as communications using contacts with existing networks worldwide.