Therapy and treatment in prison in Austria: addiction, mental health, sexual offences

Imprisonment is an interference with personal liberty, but it does not suspend the right to healthcare. Section 66 StVG enshrines healthcare as a principle of prison enforcement: the care of prisoners should meet the general standard that applies outside the institution. This principle of equivalence is the yardstick against which every treatment decision must be measured.

If a prisoner falls ill, is injured or has an accident, the prison doctor must be called in under Section 68 StVG. The doctor must ensure the necessary medical, where required specialist, treatment and care. If care within the institution is insufficient, treatment in a hospital ward, in the prison hospital or, in exceptional cases, in an external clinic comes into consideration.

Continuity is decisive. Anyone entering detention with an existing diagnosis or an ongoing therapy should bring the findings in early, most reliably through correspondence via a lawyer, which is not subject to mail screening. Documents submitted directly do not always arrive in practice. Seamless documentation prevents interruptions to treatment and is at the same time the foundation for any later release perspective.

With addiction, the law knows two separate paths, depending on whether the sentence is still ahead or is already being served. Before commencing the sentence stands the deferral under Section 39 SMG. For a custodial sentence of no more than three years for an offence connected with addiction to narcotic substances, enforcement can be deferred for up to two years if the convicted person agrees to a health-related measure. This constellation, known as therapy instead of punishment, can entirely replace enforcement in the institution.

If the treatment is completed successfully, Section 40 SMG opens the door to a subsequent conditional remission of the sentence. If the measure is not started or is broken off, the deferral is revoked and the sentence is enforced. During the deferral the court may request confirmations of the start and progress of treatment.

If the sentence is already being served, Section 68a StVG applies. It provides for the withdrawal treatment of addicted prisoners within the institution, from outpatient counselling to specialised therapy units. Participation is voluntary. Anyone who wishes to complete it should apply early, because places are limited. The benefit reaches beyond the institution, because Section 46 para 4 StGB expressly names voluntary treatment begun during enforcement as a circumstance that improves the prognosis for conditional release.

With mental illness there is a right to adequate treatment by the same yardstick as for physical conditions. The first point of contact is the prison outpatient unit. If it is insufficient, specialised care must be ensured, for example through transfer to a hospital ward or to an institution with a psychiatric focus.

If necessary treatment is refused or delayed, the enforcement complaint under Section 120 StVG is the way to enforce it. With a severe illness that cannot be adequately treated during enforcement, fitness for detention must also be examined. A deferral or interruption of the sentence on health grounds may come into consideration.

The distinction from the preventive measure is important. Placement in an institution for mentally abnormal offenders under Section 21 StGB concerns offenders lacking criminal responsibility or who are especially dangerous and is not a form of imprisonment. A mental illness during imprisonment does not automatically lead into the preventive measure, it is to be treated within prison enforcement.

With violent and sexual offences, the therapeutic engagement with the offence is not a voluntary extra but in practice the precondition for relaxations of detention and for conditional release. For relevant offences the enforcement court regularly expects proof of serious treatment begun during enforcement and capable of bearing weight. Without this proof, release at the halfway point in particular is practically excluded.

Prisons keep social-therapeutic programmes available for this, partly in dedicated units with specialised staff. Treatment against the person's will is excluded. If, within a conditional release, an instruction to undergo medical treatment under Section 51 para 3 StGB is issued, it requires the consent of the person concerned and may not order any intervention involving bodily harm.

The practical advice is to begin treatment early and to document its course. Section 46 para 4 StGB expressly recognises voluntary treatment begun during enforcement as a circumstance that can carry a changed prognosis. Anyone who coordinates therapy, enforcement plan and relaxation perspective builds, over months, the basis for an earlier release.