Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors

Fazel, Seena; Wolf, Achim; Fimińska, Zuzanna; Larsson, Henrik

doi:10.1371/journal.pone.0155906

Cited by 46 publications

(50 citation statements)

References 64 publications

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“…Previous studies on treatment outcome have suggested that the population of former forensic psychiatric inpatients remains at high risk for several adverse outcomes but seems to be at lower risk for reoffending in comparison with offenders without a mental disorder. In a longitudinal study of 6,520 patients (89.2% male) discharged from secure forensic psychiatric inpatient treatment in Sweden, Fazel, Wolf, Fimi nska, and Larsson (2016) found a high premature mortality rate of 29.9%…”

Section: Introductionmentioning

confidence: 99%

Comparison of outcome in men and women after treatment in psychiatric security hospitals in Germany

Franke

Rothe

Dudeck

et al. 2020

Behavioral Sci & The Law

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Previous research has shown that forensic psychiatric treatment reduces reoffending, rehospitalization and premature mortality. Treatment outcome varies with diagnosis, but little is known about the influence of sex, psychosocial adjustment and aftercare. To assess these variables, we interviewed male and female patients discharged from three psychiatric security hospitals in Germany in the years 2010–2017. Participants were interviewed at discharge (n = 609) and 1 year later (n = 366) about reoffending, readmissions, substance use and psychosocial adjustment. Among patients with substance use disorder (SUD), 14% reoffended, 20% were re‐hospitalized and 60% maintained abstinence. Among patients with severe mental disorder, 5% reoffended and 13% were re‐hospitalized. Significant sex differences were found in offenders with SUD. The results suggest that sociodemographic and disorder‐related risk factors are associated with treatment success and that female patients with SUD might need a specific treatment approach. Sex‐specific aspects, diagnosis and psychosocial adjustment should be considered in forensic psychiatric treatment and risk assessment.

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Section: Introductionmentioning

confidence: 99%

Comparison of outcome in men and women after treatment in psychiatric security hospitals in Germany

Franke

Rothe

Dudeck

et al. 2020

Behavioral Sci & The Law

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“…Although they report differing mortality rates they all exhibit high rates of suicide, 32%, 22.7% and 50% of the reported deaths, respectively. In addition, Fazel et al 11 noted the death of 14.2% of their cohort and Clarke et al 12 22.8% of deaths from accidental/unnatural causes.…”

Section: All-cause Mortality In Forensic Settingsmentioning

confidence: 98%

“…[1][2][3] The number of years of life lost in relation to all-cause mortality varies from 7 to 24 depending on the nature of the condition. 2 Substance use disorder (SUD) conveys the highest potential number of years lost (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24); however, this is closely followed by the ranges for personality disorders (13-22 years), schizophrenia (10-20 years) and bipolar disorder (9-20 years) demonstrating a psychophysiological influence (which we define as a physiological response mediated by biochemical pathways to psychological distress) upon morbidity/mortality beyond the physical impact of illicit substances.…”

Section: Introductionmentioning

confidence: 99%

Exploration of morbidity, suicide and all-cause mortality in a Scottish forensic cohort over 20 years

Rees

Thomson

2020

BJPsych open

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Background Premature mortality among patients experiencing forensic care is high. This paper examines the morbidity and mortality of all Scottish high secure patients in 1992/1993 and followed up 20 years later through the context of recovery. Aims To explore morbidity and delineate which patients are at greatest risk of premature mortality. To assess the extent of suicide and unnatural deaths. To establish which factors, if any, appear protective. Method Health and mortality data were extracted from national data-sets and death categorised as premature or post-expected age. Standardised mortality ratios were calculated to explore natural, unnatural and suicide deaths with Cox regression conducted to explore baseline demographics and premature death. Results During a mean follow-up of 21.1 years, 36.9% (n = 89) died, at an average age of 55.6 years. Of these, 70.8% (n = 63) died prematurely. Men lost on average 14.9 years and women 24.1 years of potential life. Five lives (5.6%) were lost by suicide and three (3.4%) by unnatural means. Conclusions In contrast to other mainstream and forensic cohorts, high rates of suicide and accidental deaths were not apparent. Risk of premature mortality is high. A greater focus upon physical health by community and in-patient services is essential.

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“…As a result, the staffing levels in forensic wards are high compared to general psychiatric in-patient care. These circumstances result in high care costs, and forensic psychiatry often represents a large part of the overall psychiatry budget, while the population is rather small in terms of the number of patients (3).…”

Section: Introduction Rationalementioning

confidence: 99%

Pharmacological Treatment in Forensic Psychiatry—A Systematic Review

et al. 2020

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Background: Pharmacological treatment is of great importance in forensic psychiatry, and the vast majority of patients are treated with antipsychotic agents. There are several systematic differences between general and forensic psychiatric patients, e.g. severe violent behavior, the amount of comorbidity, such as personality disorders and/or substance abuse. Based on that, it is reasonable to suspect that effects of pharmacological treatments also may differ. The objective of this systematic review was to investigate the effects of pharmacological interventions for patients within forensic psychiatry. Methods: The systematic review protocol was pre-registered in PROSPERO (CRD42017075308). Six databases were used for literature search on January 11, 2018. Controlled trials from forensic psychiatric care reporting on the effects of antipsychotic agents, mood stabilizers, benzodiazepines, antidepressants, as well as pharmacological agents used for the treatment of addiction or ADHD, were included. Two authors independently reviewed the studies, evaluated risk of bias and assessed certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: The literature search resulted in 1783 records (titles and abstracts) out of which 10 studies were included. Most of the studies included were retrospective and nonrandomized. Five of them focused on treatment with clozapine and the remaining five on other antipsychotics or mood stabilizers. Five studies with a high risk of bias indicated positive effects of clozapine on time from treatment start to discharge, crime-free time, time from discharge to readmission, improved clinical functioning, and reduction in aggressive behavior. Psychotic symptoms after treatment were more pronounced in

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Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors

Cited by 46 publications

References 64 publications

Comparison of outcome in men and women after treatment in psychiatric security hospitals in Germany

Comparison of outcome in men and women after treatment in psychiatric security hospitals in Germany

Exploration of morbidity, suicide and all-cause mortality in a Scottish forensic cohort over 20 years

Pharmacological Treatment in Forensic Psychiatry—A Systematic Review

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