Each patient had either a double (2 patients per room) or single (one patient per room). Each room is a regular psych ward room if you do not account the doors and windows. (We still had iron bars but these are phased out in favour of high security glas). The doors are similar to prison doors, the windows are shatter proves high security glas.

This is a good representation: https://www.wz.de/imgs/scaled/39/3/3/1/7/7/8/3/9/w709_h483_x354_y241_bed737e9084c58b2.jpg

Additionally there are multiple “special isolation rooms” per ward. These contain nothing but a ground integrated toilet (which can only be flushed from the outside) and a matress - and a lot of cameras. Patient who are in crisis can be seperated in there as an alternative to bed bound fixation.

In terms of activities: Patients have some form of therapy almost every day - either group, individual, work, ergo, etc. - as the main goal is healing/making people so healthy again that they are either no longer a danger and can step by step be released or can be transfered back into the prison system. (Tbh, both goals do not happen that often) Besides that: They can go into the yard, we also had a little veggie garden (which technically was illegal as the veggie were not allowed to be used for human consumption), meet with other patients in communal spaces, we had a open kitchen so they could cook. (Similar to prison they could order things every other week from a store) and well, if they have a TV (must be rented by the patient) can watch TV or borrow a book from a library(more on that below). The lower security wards also had a small gym and “communal activities” room with a billiard and so on, we didn’t.

Sounds nice? It isn’t. It js far worse than prison for most people and besides a few long termers who simply did not want anything to change after so many years absolutely every patient I have seen would have preferred prison

Why? While superficially the regime in forensic psychiatry sounds much more relaxed it isn’t under the surface. Almost half of all patients face measures under direct force (e.g. isolation, forced medication, fixation) within the first 4 months upon being admitted. That is MUCH more than regular prison (afaik their percentage in max sec is 5%).

Unlike prison it’s it’s much harder to get drugs in, as patients and visitors are screened much more and, even if you do, you get drug tested regularily (daily on drug rehab wards, weekly as a new entry on others) and due to staff being medical professionals (and there is much more staff per patient) the chance of getting high without anyone noticing is slim. And if you get caught ones liberties are gone, therapy will change,etc.

For medication it’s the other way around: We would monitor very very closely if patient take their medication (up to checking patients mouth with a dental mirror, regular blood tests,etc.) or switch to i.v./i.m. medication. A small percentage (afaik around 2-5%) are also medicated against their will.

The lack of activities is also an issue: Unlike prison where most people will try to get a job this is not an option in forensic psych. So if you don’t have therapy, you don’t have much to do and that is something that bothers a lot of people. This is especially valid as the access to media is also much more restricted compared to prison and that is much more individually regulated. In prison everything that is not seen as security risk must be allowed by law in terms of books. That is not the case here - it’s the opposite. Everything is forbidden unless it’s deemed that it is not impending the therapy goal - makes a big difference and is also a common source of trouble because some people are allowed things others aren’t. Another issue is the lack of education options. While I hear that has improved recently back in my day there was not much to do in that regard - while in prison you can regularily get apprenticeship, GED or even distant education uni degree. Overall basically everyone described the boredom as much worse than prison (but to a certain degree this is required for therapy to work). Adding to this is the lack of perspective - in prison you know how long you will be there. Life sentence here is 15 years and then they decide how dangerous you are. Only very few people get preventive custody or “special gravity” which means they get indefinite sentences/prolonged sentences. This is different in forensic psych. You will only get out once you are considered “healed”/sane. That can be in 15 months. Or 15 years. I had an arsonist on my ward who in prison would have had a max sentence of 5 years. He was there for 15 years and I am not sure he will be out by now.

Last but not least therapy itself is something on its own. People there first and foremost are patients. Any chance of liberties are directly connected to that (unlike prison where “behaving” is enough). So if you don’t play along you won’t get that TV. Less physical contact upon visitation (e.g. no hug allowed), you won’t get in a lower sec. ward or even have supervised trips to the outside. There are ocassional patients who try to trick the staff and manage to play along even though they really are still as sick as ever - but that has become incredibly rare. Generally speaking,though, the average patient will have less liberties than a average prison inmate. And of course therapy itself, even if you play along, is taxing. Very much so for these cases. I had a grown man cry in the fetal position on the floor for hours, another shift had a man trying to cut of his genitals with kids paper scissors (afaik he had a realisation what he has done and why and his sexual desire was a big part of it) or a man who plainly told me “my dad beat and raped me daily. They say the brain damage brought me here. I hate him for not doing it properly so I would be dead”.

So overall: It’s not a happy place and it is surely not a easy way out, not “easier” than prison.

(And as people always think they are clever and claim “yeah I will do this and that and play like I am insane and then get out after 15 months.” It doesn’t work like that - People working in forensic psych. are highly trained to find these cases and each possible inmate is screened while still in the entry ward or prison. I have yet to see someone who has sucess with that. Additionally: If you do this and get caught your sentence starts back on day 0 under some circumstances)