A N A L Y S I S A N D C O M M E N T A R Y The Treatment of Personality- Disordered Offenders in Germany Robert L.Trestman, MD, PhD, Sabine Eucker, Dipl Psych, and Ru ¨diger Mu ¨ller-Isberner, Dr med Offenders with mental illness challenge forensic systems throughout the world. Those with personality disorders present additional challenges. In this article, the authors describe relevant German legislation and the consequent forensic treatment of personality-disordered offenders in the German psychiatric and correctional systems, with a focus on the German state of Hessen. The development of laws and regulations are addressed, as are the parallels and distinctions between forensic hospitals and correctional settings. Current treatment approaches and programs are described. Research initiatives and future directions for the system, and comparisons with the system in the United States conclude the article. J Am Acad Psychiatry Law 35:229 –34, 2007 The literature documenting a high prevalence of per- sonality disorder diagnoses in criminal offenders is small but consistent. 1,2 There is also a growing body of literature on treatment of the mentally ill offender. However, very little is written or known about how different forensic systems manage and treat offenders with personality disorders. This article focuses on the approach to and implementation of management and treatment of the offender with a personality dis- order in Germany. As in most developed nations, in Germany there are two systems dealing with the treatment of personality-disordered offenders, the correctional system and the forensic psychiatric sys- tem. Which system is utilized is based first on the determination of legal responsibility for the offense and second on the offender’s risk of re-offending. The Laws Federal laws regulate the process, whether the out- come ultimately leads the offender into the correc- tional or the forensic psychiatric system. This process includes investigative proceedings, pretrial assess- ment of responsibility and risk, conviction, admis- sion to the system, discharge, probation, and the im- plementation and oversight of those measures. In the correctional system, federal laws are also the basis for processes related to treatment and prisoners’ rights and responsibilities. As a consequence of a cur- rent federalism reform, German states are expected to have more influence on the law of prison admin- istration in the years ahead. By contrast, the legal foundations of treatment dur- ing court-mandated forensic hospital treatment (hospi- tal-order sentence) are already in the domain of state law. Generally, state laws define patients’ rights and cli- nicians’ authority and responsibilities. State law also regulates the conditions under which clinicians can gradually return the patient to the community. These laws vary considerably among the 16 German states. Recently, in response to public pressure, some states have shifted responsibility for decisions about release from a secure inpatient setting away from cli- nicians to prosecutors and to the courts. Pretrial Assessment of Responsibility In Germany, legal responsibility for criminal be- havior begins at age 14. However, persons accused of Dr. Trestman is Professor, Departments of Medicine and Psychiatry, University of Connecticut Health Center, Farmington, CT. Dr. Eucker is Chief Psychologist, Haina Forensic Psychiatric Hospital (Giessen Branch), Giessen, Germany. Dr. Mu ¨ller-Isberner is Medical Director, Haina Forensic Psychiatric Hospital, Haina, Germany. Address correspondence to: Robert L. Trestman, MD, PhD, Depart- ments of Medicine and Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington CT 06030-1410. E-mail: trestman@uchc.edu 229 Volume 35, Number 2, 2007