Who’s going to leave? An examination of absconding events by forensic inpatients in a psychiatric hospital

Seeking freedom: A systematic review and thematic synthesis of the literature on patients' experience of absconding from hospital

“…This omission is significant, particularly as one or two interviews were terminated prematurely as it transpired the participants were too unwell to participate. The more recent papers (Martin et al, ; Mezey et al, ; Muir‐Cochrane, Oster, Grotto, Gerace, & Jones, ; Wilkie et al, ) showed greater consideration of ethical considerations. Furthermore, all of the papers lacked an explicit discussion of the potential role, bias or influence of the researchers in the research process; this lack of transparency indicates a lack of reflexivity, which is fundamental to rigorous qualitative research (Engward & Davis, ).…”

“…The data resulting from these five papers were considered either quite valuable or highly valuable in terms of its contribution to the review question. However, the remaining three papers employed case note analysis (Martin et al, ; Mezey et al, ; Wilkie et al, ) which relied upon clinical documentation of the patients' reasons for absconding. These papers did not engage patients' first‐hand and may have been biased by the staff completing the documentation.…”

“…Of note, the physical environment, hospital atmosphere, boredom and fear of other patients were not identified by participants in the studies undertaken in forensic settings (Martin et al, ; Mezey et al, ; Wilkie et al, ). However, in these settings patients were more likely to identify tribunals and hearings as contributing to the mental stress of the environment and motivating them to abscond; either the anticipation of impending events or disappointment where results had been unfavourable (Mezey et al, ; Wilkie et al, ).…”

“…For example, Bowers, Jarrett, Clark, Kiyimba, and McFarlane (:646) define an incident of absconding as “the absence of a patient from the ward, without permission, for more than 1 hr,” whereas Dickens and Campbell (:545) do not specify a timeframe, they simply say, “when (a patient's) whereabouts cannot be ascertained.” In other cases, absconding is reported when staff are sufficiently concerned about the patient involved (Stewart & Bowers, ). Martin, McGeown, Whitehouse, and Stanyon () have also highlighted that there is a difference between a patient truly absconding and returning late from authorized leave; a distinction which is not consistently observed in the literature. Furthermore, some researchers distinguish between voluntary and detained patients (Dickens & Campbell, ), whereas others exclude those who are in hospital voluntarily or focus on clinical areas where all patients are detained under mental health legislation, such as forensic units (Mosel, Gerace, & Muir‐Cochrane, ; Wilkie, Penney, Fernane, & Simpson, ).…”

“…Discussions of absconding are often couched in a rhetoric of risk management and prevention, characterizing it as a challenging behaviour (Cullen, Bowers, Khondoker, & Pettit, 2016;Muralidharan & Fenton, 2006). Existing literature often focuses on demographic and behavioural characteristics of patients who abscond, for example age, ethnicity, gender, diagnosis, recent medication refusal, seasonal variation or environmental disruption (Bowers et al, 1998(Bowers et al, , 2000Gerace et al, 2015;James & Maude, 2015;Martin et al, 2018;Meehan et al, 1999;Mezey, Durkin, Dodge, & White, 2015;Mosel et al, 2010;Muir-Cochrane & Mosel, 2008;Muir-Cochrane et al, 2011;Wilkie et al, 2014). Some of the literature also examines measures to reduce absconding through restrictive interventions, such as locking ward doors (Nijman et al, 2011;Stewart & Bowers, 2011;Van der Merwe, Bowers, Jones, Simpson, & Haglund, 2009), enhanced observations (Stewart, Bowers, & Ross, 2012) and using GPS location devices to monitor patients' whereabouts (Hearn, 2013).…”