Patient outcomes following discharge from secure psychiatric hospitals: Systematic review and meta-analysis

Abstract

BackgroundSecure hospitals are a high-cost, low-volume service consuming around a fifth of the overall mental health budget in England and Wales.AimsA systematic review and meta-analysis of adverse outcomes after discharge along with a comparison with rates in other clinical and forensic groups in order to inform public health and policy.MethodWe searched for primary studies that followed patients discharged from a secure hospital, and reported mortality, readmissions or reconvictions. We determined crude rates for all adverse outcomes.ResultsIn total, 35 studies from 10 countries were included, involving 12 056 patients out of which 53% were violent offenders. The crude death rate for all-cause mortality was 1538 per 100 000 person-years (95% CI 1175–1901). For suicide, the crude death rate was 325 per 100 000 person-years (95% CI 235–415). The readmission rate was 7208 per 100 000 person-years (95% CI 5916–8500). Crude reoffending rates were 4484 per 100 000 person-years (95% CI 3679–5287), with lower rates in more recent studies.ConclusionsThere is some evidence that patients discharged from forensic psychiatric services have lower offending outcomes than many comparative groups. Services could consider improving interventions aimed at reducing premature mortality, particularly suicide, in discharged patients.

A mixed-methods study exploring the characteristics and needs of long-stay patients in high and medium secure settings in England: implications for service organisation

“…154 Recent research has found a great deal of variation in outcomes internationally, with mortality rates varying between 289 and 2828 per 100,000 patient-years, readmission rates varying between 2926 and 16,641 per 100,000 patient-years and reconviction rates varying between 0 and 24,244 per 100,000 patient-years. 25 It is not clear how England compares in these outcomes internationally, although there is some indication that outcomes may be worse there than in other countries. 150 This may be due to ineffective treatment, although a more likely explanation might be the restrictive nature of services, reducing opportunities for patients to engage in varied prosocial activities, and policies (e.g.…”

“…Given this complexity, it is not surprising that rigorous evidence of 'what works' in secure care is limited. 25 Interventions typically tackle a range of treatment needs, and may include pharmacological, individual and group psychological interventions to improve symptoms as well as to reduce risk (e.g. of violent and sexual offending).…”

“…More than in other areas of psychiatry, the therapeutic milieu, with clear structures and boundaries, 24-hour nursing care, prosocial modelling, occupational activities, etc., plays a crucial role, and these more general aspects are almost impossible to disentangle from specific, time-limited psychological interventions. Despite these challenges, some evidence has emerged for the effectiveness of pharmacological interventions, psychoeducation and cognitive-behavioural approaches in high secure care, and reoffending rates following discharge from secure care are more favourable than those following release from prison (for a recent review see Fazel et al 25 ).…”

Effectiveness of Transitional Interventions in Improving Patient Outcomes and Service Use After Discharge From Psychiatric Inpatient Care: A Systematic Review and Meta-Analysis

“…Interventions aiming to improve the transition from hospital to home have been tested in studies and partly summarized in systematic reviews. These systematic reviews have either focused on a wide range of interventions, including preintervention and postintervention components (7,21), specific patient groups (22), and settings or services (23,24). For example, Vigod et al (7) found evidence from nonrandomized trials indicating that psychoeducational interventions help to improve disease management and everyday skills, which may reduce readmission rates of psychiatric patients.…”

Mentally disordered offenders discharged from designated hospital facilities under the medical treatment and supervision act in Japan: Reoffending and readmission

“…Despite several reports outlining outcomes for offender patients discharged from forensic psychiatry hospitals in European countries (Buchanan, 1998;Coid, Hickey, Kahtan, Zhang, & Yang, 2007;Davies, Clarke, Hollin, & Duggan, 2007;Fazel, Fiminska, Cocks, & Coid, 2016;Tabita, De Santi, & Kjellin, 2012), information is limited for those within Japan (Ando, Soshi, Nakazawa, Noda, & Okada, 2016). Hence, we conducted a cohort study of offenders with mental disorder discharged from designated MTSA facilities in Japan.…”