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Agequake in prisons - second part: Mental health care and forensic evaluation of aging prisoners and persons serving security measures in Switzerland

English title Agequake in prisons - second part: Mental health care and forensic evaluation of aging prisoners and persons serving security measures in Switzerland
Applicant Elger Bernice
Number 166043
Funding scheme Interdisciplinary projects
Research institution Institut für Bio- und Medizinethik (IBMB) Universität Basel
Institution of higher education University of Basel - BS
Main discipline Legal sciences
Start/End 01.02.2017 - 31.05.2021
Approved amount 515'429.00
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All Disciplines (5)

Discipline
Legal sciences
Medico-Social Problems of the Elderly
Psychology
Mental Disorders, Psychosomatic Diseases
Sociology

Keywords (10)

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

Lay Summary (German)

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

Responsible applicant and co-applicants

Employees

Publications

Publication
Incarcerated older persons’ motivation to engage in criminal court-mandated treatment: Findings from a qualitative study
Seaward Helene, Wangmo Tenzin, Egli-Alge Monika, Hiersemenzel Lutz-Peter, Graf Marc, Elger Bernice S., Habermeyer Elmar (2021), Incarcerated older persons’ motivation to engage in criminal court-mandated treatment: Findings from a qualitative study, in Forensic Science International: Mind and Law, 2, 100057-100057.
Forensic-Psychiatric Risk Evaluations: Perspectives of Forensic Psychiatric Experts and Older Incarcerated Persons From Switzerland
Wangmo Tenzin, Seaward Helene, Pageau Felix, Hiersemenzel Lutz-Peter, Elger Bernice S. (2021), Forensic-Psychiatric Risk Evaluations: Perspectives of Forensic Psychiatric Experts and Older Incarcerated Persons From Switzerland, in Frontiers in Psychiatry, 12, 1.
Chains, trains and automobiles: Medical transport for prisoners in Switzerland
Haesen Sophie, Merkt Helene, Elger Bernice, Wangmo Tenzin (2021), Chains, trains and automobiles: Medical transport for prisoners in Switzerland, in European Journal of Criminology, 1477370820-1477370820.
Court-Mandated Patients’ Perspectives on the Psychotherapist’s Dual Loyalty Conflict – Between Ally and Enemy
Merkt Helene, Wangmo Tenzin, Pageau Félix, Liebrenz Michael, Devaud Cornaz Corinne, Elger Bernice (2021), Court-Mandated Patients’ Perspectives on the Psychotherapist’s Dual Loyalty Conflict – Between Ally and Enemy, in Frontiers in Psychology, 11, 592638.
Donner à voir l'invisibleL’expérience carcérale de détenus âgés saisie par la photographie
Hummel Cornelia (2020), Donner à voir l'invisibleL’expérience carcérale de détenus âgés saisie par la photographie, in TSANTSA – Journal of the Swiss Anthropological Association, 25, 129-140.
Substance use and other mental health disorders among older prisoners
Haesen Sophie, Merkt Helene, Imber Arnaud, Elger Bernice, Wangmo Tenzin (2019), Substance use and other mental health disorders among older prisoners, in International Journal of Law and Psychiatry, 62, 20-31.
How People Traveling Abroad to Die Came to be Called “Death Tourists”, and Why They Shouldn’t
Haesen Sophie (2018), How People Traveling Abroad to Die Came to be Called “Death Tourists”, and Why They Shouldn’t, in Journal of Social Work in End-of-Life & Palliative Care, 14(4), 244-247.
Directing citizens to create advance directives
Haesen Sophie, Shaw David (2018), Directing citizens to create advance directives, in Swiss Medical Weekly, 1.

Collaboration

Group / person Country
Types of collaboration
Prof. Robert Trestman, Univ. of Connecticut United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Dr. Yvonne Treusch (advisor) Switzerland (Europe)
- Publication
Dr. Peter Wermuth, Director of Forensic Psychiatry Services Canton Argau Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Dr. Tenzin Wangmo, Institute for Biomedical Ethics, Basel Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Dr. Karine Moschetti, University of Lausanne Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Prof. Lawrence Gostin, Georgetown University United States of America (North America)
- Publication
Dr. phil. Astrid Stuckelberger (advisor) Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Prof. Dr. jur. Alexander Capron, USC United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Prof. Dr. Dr. h.c. J.-M. Jehle (advisor) Germany (Europe)
- Publication
Dr. phil. Cornelia Hummel, Department of Sociology, Univ. of Geneva Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
PD Dr. med. Ariel Eytan, Univ. of Geneva Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Dr. Philippe Delacrausaz, Univ. of Lausanne Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Prof. Dr. iur. J. Kinzig (advisor) Germany (Europe)
- Publication
Prof. Dr. med. Armin von Gunten, Univ. of Lausanne Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Prof. Dr. med. Bruno Gravier, Univ. of Lausanne Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Eurocrim Poster Aging Alone in Prison 08.09.2020 Bucharest, Romania Merkt Helene;
IAHMS Talk given at a conference Preventive detentions: An ethical analysis 12.11.2019 Montreal, Canada Haesen Sophie; Merkt Helene;
CAPL Talk given at a conference Mental Health Strategies for Older Offenders: A comparison between Canada and Switzerland. 12.06.2018 Victoria, Canada Haesen Sophie; Merkt Helene;
IAHMS Poster Accelerated Aging and How to Define an Older Offender 12.06.2018 Antwerp, Belgium Haesen Sophie; Merkt Helene;
IAHMS Poster Substance use and other mental health disorders among older prisoners 12.06.2018 Antwerp, Belgium Haesen Sophie; Merkt Helene;


Associated projects

Number Title Start Funding scheme
135035 Agequake in prisons: Reality, policies and practical solutions concerning custody and health care for ageing prisoners in Switzerland 01.10.2011 Interdisciplinary projects

Abstract

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.
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