Detention issue


FRA research findings

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Legal instruments & key provisions

Legal instrument Key provision
Code of Conduct for Detention (Anhalteordnung)Necessary medical care for prisoners has to be provided by medical officers (Amtsärzte) or by other precaution (Vorsorge) by making sure that a doctor can intervene without unnecessary delay. In minor cases paramedics may take care of prisoners. Prisoners are free to consult a doctor of their choice on their own costs. Those consultations have to take place in the cell.
Penal Code (Strafvollzugsgesetz)The health status of inmates and their weight are to be monitored. In case of illness, accident, suicide attempt or other self harm the prison doctor has to be informed and has to treat the inmate or transfer her/him to special doctors. Prisoners have to be granted the necessary dental treatments. Dentures are only provided on the own costs of the inmate.


Year Recommendation Report
2015It must be guaranteed that the medical care of detainees is on the same level as that of persons who are at liberty. The NPM considers it necessary to hire additional medical personnel, particularly for the purpose of psychiatric care in the out-patient clinic of the Stein correctional institution. Regular visitations shall help to prevent bodily and mental neglect of long-term prisoners. It was demanded that, if it was absolutely necessary to have a prison guard present during the examination of a detainee, he or she should be a person of the same gender. Under which circumstances it is absolutely necessary to have a guard present during a medical treatment (in the room at the correctional institution provided for this purpose) is still left open. Moreover, the NPM emphasises that placebo medication can only be tolerated if the patient is informed. A clear definition of the term “fitness to undergo detention” should be provided in the Code of Conduct for Detention. Particular sensitivity should be used in determining whether a person is unfit to undergo detention due to mental impairment. Police physicians should always be able to correctly assess the need for specialised treatment of detained persons based on the situation and to quickly access psychiatric expertise, if necessary, regardless of the day of the week and the time of day. The development of criteria for the medically necessary transfer of such persons to specialised clinics instead of their placement in specially secured cells could minimise the risk of jeopardising the health of this particularly vulnerable group of persons by making a bad decision. Police doctors shall inform persons, who are not able to stay in prison, prior to leaving the prison about medical measures and possibilities to allow for later care for the person. Report details
2016Only trained health care and nursing personnel should provide services in infirmaries and physician’s offices. They may not perform any supervisory functions. Prison guards may only be utilized as an exception by request of the physician due to a risk assessment. Medical experiments on inmates are prohibited by law. The prohibition is absolute. It is irrelevant whether an adverse effect can be expected from the invasive procedure. Newly admitted prisoners have to be medically checked within 24 hours upon arrival. In the interest of self-protection, the protection of others and the discovery of mistreatment, the health examination upon arrival should include a physical examination in addition to a medical history record. Prisoners who suffer from psychiatric (pre-existing) illnesses have to be brought to a psychiatric doctor in short time after admittance to the prison and are to be cared for by regular contact to the doctor. To guarantee effective suicide prevention, prisoners who hold VISCI red status, have to be brought to the psychological and psychiatric experts as soon as possible to produce an experts’ report. Report details
2017To guarantee this care under comparable conditions as for persons in freedom, medical personnel has to be available in a sufficient number. Inmates with substance abuse problems are entitled that their special treatment, care and advise necessities are taken into account. Prisoners who show psychological particularities and at the same time are not able for regular imprisonment have to be separated from other inmates and have to receive special care and therapy. Standards for care and criteria for classification have to be developed. Individual therapeutic treatments for accommodated persons have to be foreseen as well as specific rooms. Therapy has to start soon after accommodation. Months of inactivity are not acceptable. Upon arrest in special secured cells in PAZ an immediate first medical check by a doctor has to take place. If there is a suspicion of suicide risks, this has to be documented. Information of decision makers as well as medical checks have to take place. If suicide risks are confirmed, organisational measures have to take place to hinder access to dangerous items. After a suicide (attempt) immediate measures to save the life have to be conducted. Measures of crisis intervention regarding inmates have to be conducted quickly. Medical examinations and treatments of persons in police inspections have to be in general conducted by doctors alone. Police officers may only be present due to security reasons and shall not be those who conducted the arrest. At police inspections the presents of a police officer during medical examination, the name, the reasons for presence as well as the measures for upholding privacy of the inmate shall be documented. In case of being naked during a medical check the present police officer has to have the same sex as the inmate. Officers being present because of security reasons shall be out of earshot and if possible also out of sight. If possible, separate rooms for examinations shall be available at PI. In any case technical measures to guarantee a confidential medical examination have to be taken. Protection of non-smokers has to be provided in all PI. Cells may not be used as smoking zones of personnel. Report details
2018Correctional institutions: Every correctional institution must establish a multi-professional treatment team for treating substance use disorders. In addition to the addiction-based medical programme, the detainees with a substance use disorder should also be offered group therapies or clinical-psychological treatments. With the relevant indication, an opioid substitution therapy must be carried out. This must not only be the case when the patient is already undergoing extramural substitution therapy at the time of admission to the correctional institution, rather a diagnosed opioid addiction should be the basis for the same. Patients who discontinue an opioid substitution therapy must be verifiably informed that the risk of mortality increases considerably as a consequence. The reliability and the entitlement to a substitution therapy should be clarified in the law. As a rule, all persons with a substance use disorder must be housed in shared accommodation. The examination determining whether a substance use disorder exists must be performed by the medical staff during admission, at the latest, however, within 24 hours, this also applies on weekends and public holidays. If there is no medical staff available, the on-call (emergency) doctor must be consulted or the detainee transferred to a hospital if there is a suspected substance use disorder. The relevant decision may only be taken by law enforcement officers if they have appropriate additional qualifications. The administering of “one-size-fits-all medication” for withdrawal conditions always requires a doctor’s prescription. Persons in detention have the right to the same medical care as persons in freedom (equivalence principle). Detainees may thus not be excluded from therapy or medication due to lack of compliance. The request for a specific therapy, the approval of the same and/or care as well as the course of the treatment must be documented in the Electronic Patient Record Module and in the patient file. Nationwide harmonised rules for the initial interview with the psychological service and the initial psychiatric examination are required. The problem of staff shortages in the medical area must be solved urgently. A monetary incentive is required, in particular, in order to win over doctors for a position working in prisons. A visit must be carried out by a medical officer to the sections and inmate cells of the respective correctional institution once a month and documented in the Integrated Prison Administration. Diagnoses must be entered in the emergency sheet. Calling upon prison officers during medical examinations or consultations is only permissible in exceptional cases based on a dangerousness assessment when requested by the doctor. The workplace of the prison officers must be physically separated from the treatment room. Report details
2019Correctional institutions: The in-patient acute psychiatric care of detainees awaiting trial and convicts must be expanded urgently. A financial incentive is required in particular to attract medical experts to work in prisons. The vacant positions in the medical area shall be filled as soon as possible. The Electronic Patient Record Module shall be replaced quickly. A mandatory automatic follow-up appointment with the patient to discuss the results shall be scheduled after a blood test. Computer programmes for examining the interaction of medications shall be installed in all correctional institutions. Approval of therapy by the medical superintendent shall be timely. The request for a specific therapy, approval or rejection as well as the treatment procedure shall be documented in the Electronic Patient Record Module and the medical record. A comprehensive risk assessment as to which medication is the most suited in the individual case should always be carried out before substitution medication is changed. Every correctional institution shall establish a multi-professional treatment team for the treatment of substance use disorders. The examination to determine whether there is a substance use disorder shall be performed by the medical staff upon arrival, but within 24 hours at the latest, this also applies at weekends and on public holidays. In addition to the medical addiction programme (e.g. opioid substitution therapy), effective therapy options shall be offered to the detainees with a substance use disorder. An enforcement plan and an individual treatment plan shall be created during pre-trial detention for persons with a substance use disorder. The specialist services shall be granted access rights to the documentation in order to facilitate adequate treatment and care. To this end, the technical conditions shall be created while maintaining data security. Psychotherapists who are deployed in prisons should have special qualifications. The definition of the criteria, according to which they are selected, should apply nationwide. If it is not possible to offer a therapy in a language that the detainee can understand, they must – without a waiting period – be able to join a German course. Report details