Clinical predictors and patterns of absconding in a low secure challenging behaviour mental health unit

Adult missing persons: a concept analysis

“…Antecedents to adult missing person incidents from mental health facilities include receiving bad news (e.g. refusal of leave), homesickness, and worry about home, family members, and outside responsibilities (Beer, Muthukumaraswamy, Khan, & Musabbir, 2009;Bowers, Jarrett, Clark, Kiyimba, & McFarlane, 1999b;Martin & Thomas, 2014;Mezey, Durkin, Dodge, & White, 2015;Muir-Cochrane, Oster, Grotto, Gerace, & Jones, 2013;Nurjannah et al, 2009). Patients in forensic mental health settings (i.e.…”

“…A significant proportion of adult missing persons voiced their intentions to leave to the ward staff well before their departure (Bowers et al, 1999b;Mosel, Gerace, & Muir-Cochrane, 2010;Wilkie et al, 2014). Personal irritation, frustration, boredom, and fears of stigmatisation have also been named as antecedents (Beer et al, 2009;Hearn et al, 2012;Meehan, Morrison, & McDougall, 1999;Mezey et al, 2015;Mosel et al, 2010;Muir-Cochrane et al, 2013;Nurjannah et al, 2009;O'Driscoll & Walmlsey, 2010;Wilkie et al, 2014). Finally, while the antecedents mentioned thus far were mainly experienced as 'push' factors, 'pull' factors comprised largely rational concerns such as worry for the security of one's empty property rather than disorder-related explanations such as active psychotic symptoms (Bowers, Jarrett, Clark, Kiyimba, & McFarlane, 1999a).…”

“…Similarly, mental health services suffer reputational damage, loss of public confidence, legal liability, and negative media exposure as a result of adult missing persons absconding from their facilities (Bowers et al, 1999c;Muir-Cochrane, Mosel, Gerace, Esterman, & Bowers, 2011;Muir-Cochrane & Mosel, 2009;Muir-Cochrane et al, 2013). Mental health staff and family members can experience low levels of morale, emotional distress, and may feel responsible for adults going missing (Beer et al, 2009;Mezey et al, 2015;Nurjannah et al, 2009;O'Driscoll & Walmlsey, 2010). Meehan et al (1999) note that the additional workload can detract from the care of other patients (Bartholomew et al, 2009), and 'copycat' missing incidents by other patients may also occur (Martin & Thomas, 2014).…”

A Prospective Cohort Study of Absconsion Incidents in Forensic Psychiatric Settings: Can We Identify Those at High-Risk?

“…With regards to diagnosis, perhaps unsurprisingly, psychopathy and personality disorder appear to be more common among those who abscond from forensic settings [ 7 , 11 ], a finding which is consistent with that of an early study which showed that absconders are characterised by higher scores on the Minnesota Multiphasic Personality Inventory than non-absconders [ 12 ]. In contrast, one reasonably consistent finding is that the presence of psychotic disorder is not associated with higher likelihood of absconsion [ 5 , 8 , 9 , 13 ]. A number of offending and behavioural factors have also been found be more common among patients who abscond relative to those who do not, including, a violent or acquisitive index offence [ 5 , 7 , 11 ], an admission precipitated by an index offence [ 6 ], a greater number of previous convictions [ 9 ], prior substance use problems [ 9 , 10 , 13 ], and higher scores on the Historical, Clinical, Risk-Management—20 (HCR-20 [ 14 ]) violence risk assessment tool [ 10 ].…”

“…In contrast, one reasonably consistent finding is that the presence of psychotic disorder is not associated with higher likelihood of absconsion [ 5 , 8 , 9 , 13 ]. A number of offending and behavioural factors have also been found be more common among patients who abscond relative to those who do not, including, a violent or acquisitive index offence [ 5 , 7 , 11 ], an admission precipitated by an index offence [ 6 ], a greater number of previous convictions [ 9 ], prior substance use problems [ 9 , 10 , 13 ], and higher scores on the Historical, Clinical, Risk-Management—20 (HCR-20 [ 14 ]) violence risk assessment tool [ 10 ]. Finally, several studies have reported that previous absconsion is associated with increased likelihood of later absconsion [ 5 , 6 , 10 , 13 ], indicating that past behaviour is a predictor of future behaviour, or at least that the factors associated with the past behaviour are still present and increase the risk of future behaviour.…”