Absconding from Public Mental Health Inpatient Units – Who Does it, and why?

Cabarkapa, Sonja; Sadhu, Raja; King, Joel; Dowling, Nathan; Radhakrishnan, Raghavakurup; Akinbiyi, Akinsola; Srinivasaraju, Ravindra; Stevenson, Dean

doi:10.1007/s11126-020-09788-5

Cited by 5 publications

(6 citation statements)

References 16 publications

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“…Presumably, this is also reflected in a higher demand for neuroleptic drugs, which was found to be an influential factor in our sample. Our model did not identify any variables regarding childhood or adolescence and, with the exception of the two variables mentioned above, also no parameters from psychiatric or criminal history [1,4,5,17,19,23,24,38]. Hence, our analysis indicates that past patient information is less relevant than information on the current hospitalization.…”

Section: Discussionmentioning

confidence: 68%

“…Not only the age at the time of the incident was important as described in previous studies, but also a younger age at the time of the initial diagnosis of SSD. A shorter hospitalization period could also be confirmed [3,4,31,33,34,38] indicating that escape and absconding arise in an earlier phase of treatment. Although, in contrast to previous investigations, no increased incidence of diagnoses of substance abuse was found [1,4,5,23,24,33,[38][39][40], there was a higher incidence of substance abuse during the current forensic hospitalization.…”

Section: Discussionmentioning

confidence: 83%

“…The diagnosis of schizophrenia spectrum disorder (SSD) has been identified as one of the most influential characteristics for escape or absconding with incidences of up to 71% in patients examined [1,4,5,17,23,24,[27][28][29][30][31][32][33]. Further risk factors for escape or absconding included: younger age [1, 3-5, 9, 29, 33-36], male sex [1,4,5,29,30,33,[36][37][38], being unemployed [4,37,39], being unmarried [1,5,7,10,36,39], homelessness [38], the number of diagnoses [38], having a personality disorder [1,4,5,11] or affective disorder [4,5,9,33,36], prior convictions [4,17,19], forensic psychiatric treatment in the past [1], absconding in the past…”

Section: Introductionmentioning

confidence: 99%

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Escape and absconding among offenders with schizophrenia spectrum disorder – an explorative analysis of characteristics

2021

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Background Escape and absconding, especially in forensic settings, can have serious consequences for patients, staff and institutions. Several characteristics of affected patients could be identified so far, albeit based on heterogeneous patient populations, a limited number of possible factors and basal statistical analyses. The aim of this study was to determine the most important characteristics among a large number of possible variables and to describe the best statistical model using machine learning in a homogeneous group of offender patients with schizophrenia spectrum disorder. Methods A database of 370 offender patients suffering from schizophrenia spectrum disorder and 507 possible predictor variables was explored by machine learning. To counteract overfitting, the database was divided into training and validation set and a nested validation procedure was used on the training set. The best model was tested on the validation set and the most important variables were extracted. Results The final model resulted in a balanced accuracy of 71.1% (95% CI = [58.5, 83.1]) and an AUC of 0.75 (95% CI = [0.63, 0.87]). The variables identified as relevant and related to absconding/ escape listed from most important to least important were: more frequent forbidden intake of drugs during current hospitalization, more index offences, higher neuroleptic medication, more frequent rule breaking behavior during current hospitalization, higher PANSS Score at discharge, lower age at admission, more frequent dissocial behavior during current hospitalization, shorter time spent in current hospitalization and higher PANSS Score at admission. Conclusions For the first time a detailed statistical model could be built for this topic. The results indicate the presence of a particularly problematic subgroup within the group of offenders with schizophrenic spectrum disorder who also tend to escape or abscond. Early identification and tailored treatment of these patients could be of clinical benefit.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

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Escape and absconding among offenders with schizophrenia spectrum disorder – an explorative analysis of characteristics

2021

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“…However, rather than using a physical barrier such as a locked door to prevent the use of alcohol or illicit substances, greater attention should be focused on the management of withdrawal. Frequently, poor management of alcohol and drug withdrawal has been linked to absconding (Beer et al, 2009; Cabarkapa et al, 2021) and death among individuals in mental health inpatient units (Department of Health, 2012). Although providing a perceived physical barrier to alcohol and drug access, locked doors do not prevent the use of these substances on inpatient mental health units, as evidenced by using further strategies to curtail drug and alcohol use, such as detector dogs (McEvedy et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Locked external doors on inpatient mental health units: A scoping review

Searby

James

Snipe³

et al. 2023

Int J Mental Health Nurs

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The principles of least restrictive care and recovery‐focused practice are promoted as contemporary practice in the care of individuals with mental ill health, underpinning legislation concerning mental health and illness in many jurisdictions worldwide. Inpatient mental health units with locked doors are incompatible with this style of care and throwback to a time where care for mental illness was primarily custodial. The aim of this scoping review is to determine whether evidence exists for locking mental health unit doors, whether this practice is compatible with recovery‐focused care and to determine whether door locking has changed since a review conducted by Van Der Merwe et al. (Journal of Psychiatric and Mental Health Nursing, 16, 2009, 293) found that door locking was not the preferred practice in the management of acute mental health units. We used Arksey and O'Malley's (International Journal of Social Research Methodology: Theory and Practice, 8, 2005, 19) framework for scoping reviews, with our initial search locating 1377 studies, with screening narrowing final papers for inclusion to 20. Methodologies for papers included 12 using quantitative methodology, 5 qualitative and 3 that used mixed methods designs. Poor evidence was found for door locking to mitigate risks such as absconding, aggression or illicit substance importation. Furthermore, locked doors had a detrimental impact on the therapeutic relationship, nurse job satisfaction and intention to leave the profession. This scoping review indicates that research is urgently needed to address a mental healthcare culture where door locking is an entrenched practice. Studies of alternative approaches to risk management are required to ensure inpatient mental health units are truly least‐restrictive, therapeutic environments.

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“…Factors associated with absconding in previous studies included male gender (3-5, 11, 17-19), younger age (3)(4)(5)11,18,19), substance use disorder (5,13,17,19), early in their admission (2,4,5,11,17,18), involuntary status (11,17), a greater number of drugs used, higher numbers of comorbid psychiatric illnesses (17), psychiatric diagnosis of schizophrenia or bipolar mood disorder (3)(4)(5)19), staff shift time (4,5), prior history of absconding (3,20), season (2), the special day of the weak (2,17), being single, and being unemployed (19). Some factors are highly repeated in numerous studies around the world.…”

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confidence: 99%

Absconding from a Psychiatric Hospital in a Developing Country, Related Factors, and the Consequences

Yahyavi,

Faraji

2023

MJIRI

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Background: This study aimed to investigate the factors related to absconding and consequences of absconding in a psychiatric hospital in a developing country within 3 years.Methods: This was a retrograde descriptive cross-sectional study from a psychiatry hospital in a developing country, Iran. The registered data of absconding between March 2018 and February 2021 were extracted. Furthermore, a retrograde follow-up by telephone on what happened after the absconding and the remembered motives was done. The obtained data were analyzed using SPSS statistical software for Windows Version 23 by descriptive statistics. The chi-square test, Fisher exact test, Student t test, or Mann-Whitney U tests were used for data analysis. P ˂ .05 was considered statistically significant.Results: Out of 7069 admitted patients during a 36-month period, 51 (39 men and 12 women) had absconded. The total absconding rate was 0.72%. The mean ± (SD) age of the patients was 29.7 ± (10.46) years, with a range of 10 to 54 years. No statistical difference between men and women emerged in terms of age (P = 0.89). Most of the absconders were men (76%), young (mean age, 29.7 years), single (70.6%), and involuntarily hospitalized (78.4%) in an urban area (90.2%), and absconded in the evening shift (58.8%) via the route of the main gate (58.8%) in the early days of admission (5 days). In terms of psychiatric diagnosis, the highest rank belonged to bipolar disorder (33.33%) and substance-related disorders (33.33%). About one-third of absconders had a current substance-related problem and most of them had experienced withdrawal symptoms or cravings days before absconding (75%). Absconders mentioned that "no need for admission" (45.1%), "economic problems" (23.5%), and "substance craving" (13.7%) were the most common reasons for leaving the hospital. Most of the absconders were hospitalized later (70.5%). The risk for self-harm (21%) or harm to others (2%) after absconding was low. Conclusion:The general profile of absconders was concordant with previous studies. It was highlighted that economic problems in recent years had an evident impact on patients and it could be postulated that consideration of substance withdrawal may decrease absconding. It is advised to adhere to the policies that support community-based psychiatry and place an emphasis on early discharge and continuity of outpatient care.

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Absconding from Public Mental Health Inpatient Units – Who Does it, and why?

Cited by 5 publications

References 16 publications

Escape and absconding among offenders with schizophrenia spectrum disorder – an explorative analysis of characteristics

Escape and absconding among offenders with schizophrenia spectrum disorder – an explorative analysis of characteristics

Locked external doors on inpatient mental health units: A scoping review

Absconding from a Psychiatric Hospital in a Developing Country, Related Factors, and the Consequences

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