Critical Incidents During Leave From an Australian Security Hospital – A 12 Year Audit

Scott, Russ; Meehan, Tom

doi:10.1080/13218719.2016.1169572

Cited by 8 publications

(19 citation statements)

References 69 publications

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“…absconsion used. Definitions can include instances of breaching the security of an inpatient unit, accessing hospital grounds or the community without permission, fleeing from staff while on community outings, being absent for longer than permitted, or failure to return from an authorized or trial leave [1][2][3][4][5][6]8,9,[11][12][13][14]. Regardless of the circumstances surrounding the event, the potential for serious outcomes exists.…”

Section: Methodsmentioning

confidence: 99%

“…Absconsion from forensic mental health units can compromise a patient's safety and result in suicide or serious self-harm [1,5,8,15] with the risk of suicide being elevated immediately upon return of the patient to the unit [2,8,16]. Substance and alcohol use are also commonly reported during absconding with over 50% of absconders in one study reporting use on leave [2,4,[7][8][9]11,14]. There is risk of exposure to the environmental elements since many patients do not have a home to seek shelter [1,15].…”

Section: Methodsmentioning

confidence: 99%

“…Absconsion of patients from forensic mental health units can have significant consequences for the patient, hospital, and greater community [1][2][3][4][5][6][7][8][9][10][11]. Absconsion can be defined as an unauthorized leave of absence from mental health inpatient services.…”

Section: Introductionmentioning

confidence: 99%

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Absconsion from forensic psychiatric institutions

2019

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Background: Absconding from mental health units is referred to as a patient leaving without permission and can have significant consequences for the patient, family, community, and institution. The varying definitions of absconsion involve breaching security of an inpatient unit, accessing grounds or community without permission, gaining liberty during escorted leave or being absent for longer than permitted from authorized or trial leave. While considerable literature exists on absconsion from acute psychiatric units, there is a paucity of literature specific to forensic absconsions, despite inherent differences between patients and systems. Forensic patients are offenders who are found unfit to stand trial, or not criminally responsible on account of mental disorder. The literature indicates the absconding rate within the forensic population is expected to be low, based on the fact that the level of security in forensic units is higher than general psychiatric units. Despite the rates being considered low, the outcomes of absconding in this population can potentially be serious, thus the exploration of factors surrounding these incidents is essential. Purpose: To review the literature regarding absconsion from forensic psychiatric institutions. This review will identify potential risk factors and motivations of forensic patients that have absconded. Methods: Electronic database and hand searches were conducted to locate articles pertaining to absconding specific to forensic psychiatric institutions published from 1969-present. Search terms included “abscond”, “escape”, “AWOL”, “runaway”, “psychiatric inpatient”, “forensic institution”, & variants. All full-text articles meeting inclusion & exclusion criteria were appraised for qualitative themes, limitations, and assessed for risk of bias using appropriate CASP Checklists. The review is structured following the PRISMA checklist and framework. Results: A total of 19 articles meeting literature review criteria were identified. The majority of the articles were of retrospective case-control design (n=12). Three systematic reviews were found on absconsion that included analyses from both forensic and general psychiatric populations. Definitions for absconding were omitted or varied making comparisons between studies difficult. Much research compared demographic, static and dynamic factors. History of previous absconsion, scores on validated risk-of-violence assessment tools, substance-use disorder, acute mental state, and socio-environmental factors were consistently noted as risk-factors. Four distinct motivations for absconding emerged: goal-directed, frustration/boredom, symptomatic, and accidental. Overall, the literature suggested forensic absconsion was a rare event of short duration with low risk to the public and few re-offending incidents. Conclusions: There is a paucity of literature on forensic absconsions. A consistent definition of absconsion and use of standardized reporting protocols across forensic programs would be beneficial in order to be able to compare data on absconding events. Also, prospective studies should be undertaken to better understand the motivations and dynamic risk factors of forensic patients who have absconded and would help inform a forensic absconsion risk assessment protocol.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Absconsion from forensic psychiatric institutions

2019

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“…Risk assessment. Of 15 forensic studies, most described individualised violence or offending-related risk assessment for leave purposes (Hearn, 2013;Lyall & Bartlett, 2010;Walker, 2013;Scott et al, 2014;Claxton et al, 2006;Scott & Meehan., 2016;Hilterman et al, 2011;Tully et al, 2016). Additionally, half the civil studies addressed leave risk assessment (Atkinson et al, 2002b;Atkinson et al, 1997;Bolin et al, 1968;Sensky et al, 1991;Barre, 2003).…”

Section: Study Synthesismentioning

confidence: 99%

Systematic review of therapeutic leave in inpatient mental health services

Barlow

Dickens

2018

Archives of Psychiatric Nursing

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“…a prediction of risk that does not happen), the ongoing loss of liberty by remaining in forensic services, as well as economic and political consequences. Risk averse practice can also affect the therapeutic relationship, and be perceived as harmful, arbitrary, or punitive by patients (Scott and Meehan, 2017).…”

Section: Introductionmentioning

confidence: 99%

Discharging inpatients with intellectual disability from secure to community services: risk assessment and management considerations

Chester¹,

Brown

Devapriam

et al. 2017

AMHID

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Purpose There is increasing emphasis on caring for people with intellectual disabilities in the least restrictive, ideally community settings. Therefore, the purpose of this paper is to explore the risk factors considered by clinicians involved in discharging people from secure services. Design/methodology/approach The views of five senior clinicians were sought in semi structured interviews. Data were analysed thematically. Findings Themes related to risk assessment, risk management, and multidisciplinary and multiagency working. Illustrative quotes are used to evidence themes. Practical implications This study described the risk assessment and management factors considered during the discharge of patients from secure to community services, which are of direct relevance to multiple stakeholders post-Winterbourne. Originality/value Challenges when facilitating discharge were highlighted, such as ongoing risk management issues, or unexpected discharge from tribunals, and how these were addressed, via the development of extensive risk assessment and management processes, and interdisciplinary and interagency working.

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Critical Incidents During Leave From an Australian Security Hospital – A 12 Year Audit

Cited by 8 publications

References 69 publications

Absconsion from forensic psychiatric institutions

Absconsion from forensic psychiatric institutions

Systematic review of therapeutic leave in inpatient mental health services

Discharging inpatients with intellectual disability from secure to community services: risk assessment and management considerations

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