Vitos forensic-psychiatric outpatient clinic in Hessen
The Vitos Forensic-Psychiatric Outpatient Clinic Hesse was founded in 1988 as an institute outpatient clinic at what is now the Vitos Clinic for Forensic Psychiatry Haina. It is the oldest, continuously working special outpatient clinic in Germany in the field of aftercare for mentally ill lawbreakers. Since January 1990 the aftercare outpatient clinic has been recognized as a psychiatric institute outpatient clinic (PIA) by the cost bearers in accordance with Section 118 of the Social Code Book V and has been an independent branch of Vitos Haina gGmbH since 2009 with locations in Haina , Gießen , Kassel , Schotten , Eltville am Rhein and Riedstadt .
The primary task of the outpatient department (FIA function; forensic institute outpatient department) is the follow-up care of conditionally discharged, former patients of the Hessian penal system for mentally ill lawbreakers (Section 63 StGB). The FPA specializes in the assessment of individual risks, their assessment and assessment as well as adequate risk management for mentally ill or disturbed people with and without a forensically relevant background.
treatment
As part of the genuine object of the specialized clinic follow-up care of according to § 67 d Abs occurs. 2 StGB caused from the stationary forensic Hessens redundant, mentally ill patients at the time of supervision of (N = 199) or arranged to §68c StGB permanent guide supervision ( N = 33). In accordance with the state's legal situation, patients are also cared for who are on leave of absence from open inpatient detention for a period of six to a maximum of eight months in accordance with Section 9 of the HessMRVollzG for the purpose of testing a conditional discharge (so-called discharge vacationers, N = 25). This clientele, who in most other federal states as so-called trial residents or long-term leave of absence form the (exclusive) core group of aftercare, regularly only accounts for around 10% of the total clientele in Hesse over all years (currently 8.7%); they continue to be regarded as prisoner of justice patients and, according to § 28 (3) HessMRVollzG, have a right to preventive health care from the competent institution of the prison system. A further 7.7% of the clientele is made up of subjects who were previously not treated as an inpatient and who received a measure according to §63 StGB during a main hearing, which was suspended at the same time with their order under conditions and instructions for probation (§67b StGB, N = 22).
Admission and financing modalities
Finally, the specialist outpatient department looks after a few other subjects who, for example, received a suspended sentence in criminal proceedings under the condition of forensic follow-up, whose temporary placement is suspended until the main hearing or who, as so-called offenders, are to be prevented from committing a crime by outpatient care (N = 7). All in all, in this predominantly criminally regulated context, the outpatient department looked after 286 test subjects across Hesse as of December 1, 2010.
In addition, the specialist outpatient clinic also functions as an aftercare facility for test subjects who, although they bear forensic and / or psychiatric risks, are not (no longer) subject to the above legal framework (PIA function; psychiatric institute outpatient clinic). These are mainly former subjects who are no longer under management supervision (N = 67), but also general psychiatric high-risk patients with regard to violent and / or criminal misconduct (N = 104) as well as people who are facing (threatening), use the specific services of the outpatient clinic during or after prison (N = 9). This second group of subjects supervised by the outpatient department currently consists of a total of 180 people.
In addition to the legal framework - criminal aftercare for the primary clientele, the voluntary nature of the secondary clientele - the main difference lies in the financing. The forensic-psychiatric outpatient clinic has been financed to the extent of the primary clientele on the basis of a cabinet decision since 2002. The calculation basis is a so-called caseload-supported financing according to the model “1 ambulance employee for 11 test persons”; In addition, 4.0 management and 4.0 full-time doctor assistant positions are financed. Since the aftercare outpatient clinic is recognized as a PIA, all test subjects, provided the formal requirements are met, can use PIAs for around € 238 / quarter or € 2.50 / calendar day for the funding of care for mentally ill people in Hesse KV are billed. The proceeds from this flow back to the country. With actual costs in 2010 of € 29 per day of care, the State of Hesse is currently assuming more than 85% of the total costs of the outpatient clinic.
Treatment contracts or treatment agreements are concluded with all test persons, which incorporate a binding force into the work that is also legally effective. In the case of care for the primary clientele, the outpatient department is usually commissioned by including it in the instructions for the respective discharge decision.
The staff of the aftercare outpatient clinic is currently made up of 6 specialists , 6 doctors with many years of experience , 3 psychological psychotherapists , 4 psychologists , 4 specialist nurses , 3 nurses , 1 remedial nurse and 6 social workers - social pedagogues who look after the "shared management principle". 5 medical assistants support the work.
There is an electronic network between all locations for the rapid exchange of information and data, both with one another and for communication within the care network, with the probation service or the judiciary. With regard to the cooperation with the judiciary, there are very short distances to the penal enforcement chambers responsible for conduct supervision processes , while in Hesse the executive supervisory bodies traditionally take up little space within these specific leadership supervision.
Currently, around 64% of the test persons are looked after exclusively (1999: 47% from 2 locations), another 20% alternately. Conceptually, this approach is based on the knowledge that the core task of forensic follow-up care - the repetitive cascade of risk assessment - forecasting - risk management can only be carried out in a qualified manner through insights into the immediate vicinity of the test persons and through contact with important reference persons from the life and work area of the clientele. After a first, very thorough assessment of all newly admitted test subjects with regard to their psychosocial abilities, wishes and needs, medical diagnoses and drug therapy as well as individual forensic risks, a "first aid or alarm" and a therapy plan are drawn up for the duration During the care, the test subjects are classified in a step-by-step plan developed for outpatient purposes, which, based on the risks inherent in the subject, stipulates the intensity of care. The contact frequency fluctuates between monthly one-time contacts and several contacts per week and is based on the principle of ACT (assertive community treatment).
Admission and funding of "external test subjects"
All potential external FPA test persons (test persons from or before / instead of prison, forensic and / or psychiatric high-risk test persons, all non-Hessian test persons) can get an appointment in the team and in the rooms of the regionally responsible FPA branch. The prerequisite for this is that all available and relevant test subject documents (currently kept files, preliminary findings, reports, etc.) are made available for inspection at short notice, that the potential test person has been released from the client's obligation to maintain confidentiality and that the financing of the admission process is ensured. The costs for the initial exploration and brief assessment result from the time required, multiplied by the JVEG rate applicable to forecast reports (Section 9, Paragraph 1; Annex).
If these conditions are met, i. d. Usually the interview date no later than two weeks after receipt of the documents. Possibly. This is followed by further appointments (e.g. to carry out test psychological examinations or to explore close relatives) to validate the information that has become known up to that point.
On this basis, a brief written report, in which the diagnostic and forensic assessment as well as any resulting questions of individual risk management or other therapy recommendations are regularly presented, is created and left to the client.
An inevitability of care by the FPA results from going through the above. Investigation not. Even the decision of a court to present oneself in the outpatient department or to be treated or looked after by the FPA or the inclusion in the safety management does not justify any measures by the FPA without the procedure outlined above.
Supervision by the FPA also requires the test person's consent to the proposed therapeutic measures, possibly plus the assumption of a control function and reporting to the client / the court. The sole assumption of an intensive psychosocial control function is usually not an indication for care.
If, in individual cases, the indication for care is made, this can only be used after further financing and cost commitments from third parties have been secured. The financing rate depends on the type of the indexed offers. Purely medical-psychiatric and / or psychotherapeutic (individual / group) therapies are charged according to the currently applicable billing rates (GOÄ or EBM; GOP). Comprehensive regular care by the FPA (therapeutic measures plus control) requires an individual cost commitment, which varies between 40 and 100 € / supervised calendar day, depending on the necessary care intensity.
Traffic light principle
In practice, forensic follow-up is based on the traffic light principle, according to which, depending on the current risk assessment, in-patient interventions (red), intensified follow-up care (yellow) and / or (specific criminal) therapeutic interventions (green) take place. The spectrum of therapy offers ranges from core psychiatric interventions such as diagnostics and psycho- / socio- and pharmacotherapy of psychiatric disorders to the formation and coordination of follow-up networks to specific criminal therapeutic interventions for violent and sex offenders (reasoning & rehabilitation, relapse prevention programs).
The aim of forensic-psychiatric follow-up care is to prevent (further) criminal acts by ensuring the necessary outpatient psychiatric-psychotherapeutic basic therapy and enabling the test subject to live independently within existing social structures in a psychologically stable and punishable manner. The success rate is high: well over 90% of all previously supervised subjects remained relapse-free in a mean follow-up period of 3.3 years (min .: 0 days, max .: 20 years, median: 3.0 years).
Multi-professional teams are currently working from five locations (Haina, Kassel, Gießen, Schotten, Eltville-Eichberg; red points; see Hessenkarte). In the coming years, a sixth location will be added at the future clinic in Riedstadt. The supply regions are based on regional courts and local community psychiatric structures.
In Hadamar, in the far west of Hesse, there is also a forensic aftercare outpatient clinic for former inpatient correctional prison patients according to Section 64 of the Criminal Code; In the near future, another aftercare location will also be built here at the new Merxhausen clinic.
Track record
Successful + failed quarter IV-1988 to quarter III-2010
| FPA subjects without EXOTES | Percentage ownership % | Pbd./year (22; 0 years) | Successful + Failed |
|---|---|---|---|
| 1072 | 48.7 | at-risk-to-fail candidates, including those on vacation (EU citizens), of which | |
| 42 | s. u. | 1.9 | died in the course 10 × suicide, 10 × CA, 20 × natural death; 2 × unclear |
| 394 | 83.0 | 24.9 | Follow-up successfully completed without any new delinquency |
| 454 | s. O. | still in FPA aftercare | |
| 130 | 12.1 | 5.9 | failed without offense, with violation of instructions
(including EU citizens N = 43 / 33.3% [17 / 22.7%; 21 / 23.1%; 38 / 35.2%; 40 / 32.5%]) |
| 52 | 4.9 | 2.4 | failed with delinquent behavior (including EU'ler 4 [1; 2; 2; 4])
60% relapse the same (N = 31), 35% relapse more easily (N = 18), <6% relapse more severe (N = 3) 1× Vergew. Sex mG + Mord (2000);
1× schw. Brandstiftung KV (2002);
1× gef. KV, Raub Sex mG (2006);
14x new 63, 5 × detention, 33 × revocation of old 63 |
literature
- R. Freese: Outpatient crime therapy. Psychiatric Criminal Therapy - Volume 2; Pabst Science Publishers, Lengerich 2003; ISBN 3-89967-036-1