Predictors of length of stay in forensic psychiatry: The influence of perceived risk of violence

Abstract

This study describes the prevalence of adverse events and length of stay in forensic psychiatric patients with and without a restriction order. Detailed clinical and administrative information from medical records and written court decisions was gathered retrospectively from admission until discharge for a Swedish population-based, consecutive cohort of forensic psychiatric patients (n=125). The median length of stay for the whole cohort was 951 days, but patients with a restriction order stayed in hospital almost five times as long as patients without. Restriction orders were related to convictions for violent crime, but not for any other differences in demographic or clinical variables. The majority of the patients (60%) were involved in adverse events (violence, threats, substance abuse, or absconding) at some time during their treatment. Patients with restriction orders were overrepresented in violent and threat events. Previous contact with child and adolescence psychiatric services, current violent index crime, psychotic disorders, a history of substance, and absconding during treatment predicted longer length of stay. Being a parent, high current Global Assessment of Functioning scores, and mood disorders were all significantly related to earlier discharge. In a stepwise Cox regression analysis current violent index crime and absconding remained risk factors for a longer hospital stay, while a diagnosis of mood disorder was significantly related to a shorter length of stay.

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

“…Within these areas, data were subject to open coding 76 to identify categories that represented key issues discussed by participants. During this process, themes emerged within each of the areas.…”

“…12,26,28,29,33,34,37,[39][40][41][42]57,74, Eleven countries were represented: the UK (n = 22 12,26,28,29,33,34,37,39-42,77-80, 82,84,86,87,89,92,97 ), the USA (n = 4 90,94,96,99 ), Ireland (n = 2 81,98 ), Germany [n = 2 93 (one of which was personal communication: Dönisch-Seidel, Ministerium für Gesundheit, Emanzipation, Pflege und Alter des Landes Nordrhein-Westfalen, 2013)], Croatia (n = 2 57,88 ), Australia (n = 1 85 ), Malaysia (n = 1 83 ), New Zealand (n = 1 95 ), Norway (n = 1 91 ), the Netherlands (n = 1 74 ) and Sweden (n = 1 76 ). The studies from the UK had samples drawn from high secure (n = 5 29,33,78,84,89 ), medium secure (n = 14 26,37,[39][40][41][42]77,79,80,82,86,87,92,97 ) and mixed secure (n = 3 12,28,34 ) settings.…”

Patient characteristics related to length of stay in Dutch forensic psychiatric care

“…However, more recent studies showed that many inpatients in UK medium and high secure hospital (34 and 66%) have a mean LOS substantially exceeding 2 years (Shah et al, 2011). Studies in other European countries report mean LOS of 5.8 years in Sweden and Germany (Andreasson et al, 2014;Ross et al, 2012), 6.7 years in Croatia (Margetić et al, 2014) and an increasing LOS from 6.1 years (O'Neill et al, 2003) to 7.6 years in Ireland (Davoren et al, 2012). Also in the Netherlands, the average LOS of a forensic inpatient in high security provision rose from 5.6 to 9.8 years between 1990 and 2009 (Nagtegaal, Horst, & Schönberger, 2011).…”

“…In recent years, more attention has been drawn to length of stay (LOS) in forensic psychiatric care (Sharma, Dunn, O'Toole, & Kennedy, 2015). In several Western countries, the average duration a patient stays in highly secure forensic settings has been rising (Andreasson et al, 2014;Davoren et al, 2012;Margetić, Margetić, & Ivanec, 2014;O'Neill et al, 2003;Ross, Querengässer, Fontao, & Hoffmann, 2012;Shah, Waldron, Boast, Coid, & Ullrich, 2011;Sharma et al, 2015). Two decades ago researchers in the UK reported mean LOS in medium security was less than 2 years (Maden, Friendship, McClintock, & Rutter, 1999;McKenna, 1996).…”

“…Many studies have investigated patient characteristics affecting LOS in forensic psychiatry in several European countries and in the US (Andreasson et al, 2014;Davoren et al, 2012Davoren et al, , 2015Lammers, Nijman, & Vrinten, 2014;Margetić et al, 2014;Moran et al, 1999;O'Neill et al, 2003;Ross et al, 2012;Shah et al, 2011). Some of the factors found to be related to LOS were only found in some of the studies.…”