Forensic Treatment of Young People as a Chance
By Laura Kirschbacher
Forensic treatment of young people is an area of conflict: Between rules and educational work, on the one hand and the opportunities for teenagers’ and adolescents’ personal development, on the other hand. Between reform and safeguarding, between educational missions and instructions for building up relations. Between these conflicting priorities is also the social therapeutic ward (ST, for short, or JMRV, forensic treatment of teenagers and adolescents) at Pfalzklinikum in Klingenmünster. Treated in forensic institutions are persons regarded not criminally responsible or having only reduced criminal responsibility, who are expected to still act dangerously and where a connection between criminal offence and mental disorder exists.
In Klingenmünster, about 20 persons aged 16 to 23 are institutionalized1, either according to § 63 StGB, the Criminal Code of the Federal Republic of Germany, in a psychiatric hospital or according to § 64 StGB in a detoxification center. The law applied is the juvenile criminal law with the goal of resocialisation. And even though forensic treatment in Germany is the domain of each state there is one general principle: teenagers and adolescents convicted according to the Juvenile Court Act are to be institutionalized separately from adults. In Klingenmünster this means separately from the forensic clinic for adults and connected to the clinic for child and adolescent psychiatry, psychosomatics and psychotherapy. In this way, the latest standards of psychiatric and psycho-therapeutic treatment of teenagers and adolescents shall be met, and the special needs of teenagers and adolescents shall be taken into account. Like all clinical Pfalzklinikum institutions, JRMV also has a dual management structure: Dr. Wolfgang Weissbeck is the senior physician for forensic treatment and the head of institutionalisation for teenagers and adolescents, Ralf Dreisigacker is the team leader, i.e. he has an educational and nursing background.
So much about the roughly outlined legal background – but I want to get to know the every-day life and therefore accompany the ST team for one day. First, the team leader, Ralf Dreisigacker, leads me through the different wards: With intensely secured, secured and open areas as well as apartments for the preparation of a discharge ST represents large forensic institutions on a small scale. Ward rounds have just been over, and while the team is meeting for peer consulting, the adolescents are having school or German classes, therapeutic one-to-one conversations, occupational therapy, are doing an internship outside or simply enjoy free time this morning. A glance at the weekly schedules reveals how a structure is established by activity offers without overloading the adolescents with too many appointments. As the senior physician Dr. Wolfgang Weissbeck explains, all this happens in view of the fact that they have an educational mission, on the one hand, and the special development tasks of the persons spending their youth in the institution are to be heeded, on the other hand. He adds that as early as possible the relaxing phase “taking out” is thus granted to avoid hospitalisation and train every-day life accompanied by a staff member. The primary goal of special therapy offers, criminal offence work and prevention is to reduce the risk of reoffending and, in doing so, consider individual risks to be avoided in future. Where possible, Relatives are included in therapy offers.
Young people institutionalized here still have their lives ahead of them and shall be prepared to live their life crime-free. Many institutionalized persons of this age lack life experience beyond a certain milieu, often they have not been to school for a long time, they lack maturity and show increased impulsivity. They consider education a penalty and for this reason it is easier to get through to them by building up relations. It is the educational mission that makes the difference between forensic treatment of teenagers and adolescents and forensic treatment of adults.
Every-day life in ST is therefore a continuous weighing of the necessary rules and the freedom needed to mature individually. For example, the rule that no violence-glorifying music is permitted, but the freedom to express one’s own experiences through rap texts. Every-day life also implies learning every-day activities: In the laundry room the washing machine is spinning, in the lounge two adolescents are laying the table for lunch. A young man proudly shows me his works produced in art therapy; another man is brooding over a crossword puzzle. Indeed, with one exception, all teenagers and adolescents living on the ward are male, the rate of female institutionalized persons in forensic institutions in Germany is 4 – 5 % according to Dr. Wolfgang Weissbeck2.
Around noon a new arrival comes from the Schifferstadt juvenile detention center. He was transferred to Klingenmünster for a withdrawal therapy. Admissions to ST do not happen all that often and, in most cases, they are scheduled. First a psychotherapist explores him, then the group leader familiarizes him with the premises, organisational procedures, attitude within the institution (“non-violent space”), ward rules. Later a talk with Dr. Weissbeck is taking place. Afterwards the young man is being assigned to one of the areas. Another topic on the agenda that day is the team meeting in which the steps of relaxation and the requests for relaxation are discussed. Provided that the teenagers/adolescents are present, the decisions are explained to them immediately. To me it seems therefore that the procedure is very transparent, and the staff has a caring attitude. By carrying out patient surveys of his own and reviewing them with the adolescents afterwards, Dr. Weissbeck, Ralf Dreisigacker and their team show how important patient orientation is to them. Once a week the adolescents have the opportunity to express wishes, praise and criticism during the department conference.
Having spent a day on the ST wards, I have great respect for the people working there, living multi-disciplinarity and, as it seems to me, managing to develop good relations to the young. ST is known and honoured for different projects developed thanks to the staff members’ commitment. Among these projects are own radio station, a band, and a beekeeping project. The employees have to meet specific requirements, they are trained in DBT-A (dialectical behaviour therapy for adolescents) or DBT-F (dialectical behaviour therapy for forensic patients), two de-escalation trainers belong to the team, and they all have in common that they look at the adolescents in a resource-orientated and appreciative way. This also requires supervision and an aftercare concept after stressful situations.
ST is forensic treatment, but it is also a living group, it is therapy, but it is also practicing of every-day life, and it has a great responsibility for the long life often still awaiting the adolescents.
1The term adolescent is used in this text when referring to institutionalized persons whose age corresponds roughly to the nationwide average age of teenagers and adolescents in forensic clinics. In JMRV in Klingenmünster, persons aged 14 to 21 can be admitted but the upper age limit is flexible so that young people on the road towards discharge must not necessarily change into the forensic clinic for adults.
2 For more information on Forensic Treatment of Young People in Germany (in German): Dr. Wolfgang Weissbeck: Jugendmaßregelvollzug in Deutschland: Basisdokumentation, Einrichtungen, Konzepte. 2009; MWV Medizinisch-Wissenschaftliche Verlagsgesellschaft.