The types of care provided vary according to the prison size. At least one health unit is present in each of them. It allows for the provision of routine care. Most of the time, specialists (dentists, dermatologists, etc.) are consulted outside of the prison. Visits must be authorised by a general practitioner. The number of health care staff varies from one state to another. The ratio is one doctor per 127 prisoners at Heidering prison. The authorities in several states use telemedicine to cope with the shortage of staff.

Prisoners requiring hospitalisation are usually transferred to a prison hospital, such as Hohenasperg (Stuttgart), Lingen (Bremen and Lower Saxony), Willich (Düsseldorf) and Plötzensee (Berlin). They are transferred to a public hospital when the administration considers that they do not present any risk.

Continuity of care is ensured throughout imprisonment. It is not provided after release. There is no coordination between prisons and public health services.

Prisoners do not choose their doctor. Care is provided by the prison doctors. The quality of care highly depends on the prisons’ investments.

The most common diseases are of infectious origin (hepatitis A, B or C). Addictive disorders are usually associated with them.

Few prisoners with Hepatitis C and HIV have access to treatment. Delayed treatment is frequent.

Preventative measures for epidemic and contagious diseases are implemented.

The authorities have reduced their efforts to implement risk reduction programmes, particularly in Bavaria. No needle exchange programmes are offered. In Fühlsbüttel prison (Hamburg), the automated machine which allowed to exchange needles has been removed.

Condom distribution is very rare.

Correctional facilities

As a rule, people with mental health disorders are placed in the general population sections of correctional facilities. They can receive psychiatric care as outpatients.

“Socio-therapeutic” (SothA) units within correctional facilities provide psychological and therapeutic treatments. These units typically hold prisoners convicted of sexual offences or serious personal injury. They are managed by teams that include psychologists, educators and social workers. They are under the direction of the regional Ministry of Justice.

The CPT observed that psychiatric care was inadequate in the Bayreuth and Gelsenkirchen prisons. Prison management had trouble transferring prisoners with acute mental disorders to a suitable therapeutic environment.¹

The NPM indicated that, in 2021, one prisoner had been in solitary confinement for over a year in the correctional facility of Bautzen (Saxony) due to his mental illness and a lack of understanding of that illness. He could not be transferred to the Leipzig prison hospital, as it lacked available spaces. The NPM noted similar cases in the correctional facility of Schwalmstadt (Hesse).²

Psychiatric units (APP) in prison hospitals

Some prison hospitals have psychiatric units for prisoners with mental disorders whose treatment requires hospitalisation. APPs are under the direction of the regional Ministry of Justice.

General psychiatric hospitals

A prisoner can be transferred to a general psychiatric hospital in case of emergency. The Ministry of Health is the authority in charge of these hospitals. Prison guards or police officers are responsible for security when prisoners are hospitalised.

Forensic psychiatric hospitals

German law stipulates that a person with a mental disorder at the time of their offence must complete compulsory treatment called a “preventive measure”. This type of measure must be distinguished from a sentence. Forensic psychiatric hospitals are dedicated to receiving these individuals.³ These facilities are overseen by the Länder. Some are part of general hospital complexes, while others are independent facilities.

A prison sentence can be accompanied by a “preventive measure”. People serving both are placed in forensic psychiatric hospitals before being incarcerated.⁴

Individuals sentenced to “preventive measures” may be placed in general psychiatric hospitals if there is not enough space available in the forensic psychiatric hospitals. This situation is relatively uncommon.

The training provided to prison guards and medical staff on handling mental disorders varies from one facility to another.

Correctional facilities

Prison guards take psychology and criminology courses as part of their training, in addition to completing work placements. They can continue their professional development by receiving additional training in psychology provided by associations. In Berlin, “group leader” guards are trained in handling prisoners with mental disorders.¹

Outpatient mental health care is provided by doctors, often general practitioners. The CPT observed that, in the prisons of Celle and Tonna, only one psychiatrist visited prisoners, and only once a week. It noted that, in all the facilities visited, including those with care units, nurses were only present during the day.² The reliance on medication for managing mental disorders in the prisons of Hamburg has risen since the Covid-19 health crisis began and led to an increase in disorders. Certain orders of medication have doubled or even tripled.

Psychiatric units (APP) in prison hospitals

Psychiatric care units are staffed exclusively by healthcare workers. The nurses receive six months of prison guard training. The healthcare workers generally receive training focused on the care of incarcerated persons.

Forensic psychiatric hospitals

Each Land determines the composition of the teams working in its forensic psychiatric hospitals. In most facilities, the surveillance staff exclusively works outside of the buildings. The healthcare workers generally receive training focused on the care of incarcerated persons when they are hired. At the Brandenburg prison, healthcare workers take part in annual obligatory training courses on restraints and psychological crisis management.³

The law states that prisoners suffering from addictions may be placed in detoxification centres.
Six states provide comprehensive treatments for addictions in some prisons¹. All prisons are obliged to offer methadone substitution treatment. It is administered by prison staff under the supervision of medical staff and social workers.
Most patients receive a single detoxification course with substitution treatment. Only a minority of prisoners with addictions access treatment for more than six months.
Marlene Mortler, Federal Commissioner for Drug Control, laments the fact that prisoners do not always have access to methadone, an opiate substitution treatment. Half of the Bavarian prisons do not provide treatment for heroin addiction. The difficulty in accessing substitution treatment promotes the black market for drugs in prison and increases the risk of infections from used syringes.
In 2016, the European Court of Human Rights described the refusal to provide substitution treatment to a dependent prisoner, as “inhuman treatment”.