External factors influencing length of stay in forensic services – a European evaluation

Connell, Catriona; Seppänen, Allan; Scarpa, Franco; Gosek, Paweł; Heitzman, Janusz; Furtado, Vivek

doi:10.12740/pp/99299

Cited by 15 publications

(7 citation statements)

References 21 publications

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“…Finally, some studies have explored the external factors associated with LOSs, and a large-scale study of 16 European countries identified four major themes concerning external factors. The factors are care and treatment pathways, resources, legal and systemic impacts, and shared expertise ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting Length of Inpatient Forensic Stay: Retrospective Study From Czechia

2022

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ObjectivesThe length of forensic stay (LoS) is a subject to country-specific legal and service systems. Therefore, the identification of common factors targetable by treatment is at the forefront of forensic psychiatric research. In this study, we present the first reports of forensic characteristics of patients from the Czechia.MethodsWe conducted a retrospective analysis of data from 260 inpatients discharged from the Bohnice Hospital (Prague) and obtained a set of sociodemographic and clinical variables as well as the Health of the Nation Outcome Scale (HoNOS) and HoNOS-secure scores.ResultsThe following variables were identified as significantly associated with a longer LoS: older age, length of previous psychiatric hospitalization, olanzapine equivalent, clozapine treatment, psychosocial dysfunction, psychotic or paraphilic disorder diagnosis, and sexual offense. A shorter LoS was associated with being in a relationship, being employed before hospitalization, receiving personal support, and committing an index offense under the influence of substance. While the HoNOS score and HoNOS symptom subscale predicted a longer LoS, the HoNOS-secure subscale predicted a shorter stay.ConclusionIn the European context, our hospital has a relatively low LoS. The results are consistent with findings linking psychotic disorders and paraphilia with a longer LoS in forensic treatment. Higher doses of antipsychotic medication or clozapine prescriptions were associated with a longer LoS. The results show a high level of unmet needs in this population, highlighting the importance of the availability of follow-up service.

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Section: Introductionmentioning

confidence: 99%

Factors Affecting Length of Inpatient Forensic Stay: Retrospective Study From Czechia

2022

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“…Factors associated with LoS of forensic inpatients may be attributable to clinical patient characteristics, including the course of disease and severity of symptoms, compliance with previous treatment, available social and family support, and a history of aggression or criminal involvement. In addition, external factors like the unique characteristics of each European country's judicial system, criteria for admission, amount of resources for general psychiatric care staff, and social and community support may also influence LoS (8).…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing Length of Stay of Forensic Patients: Impact of Clinical and Psychosocial Variables in Medium Secure Setting

et al. 2020

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Objectives: Forensic psychiatric care has two, often contradictory, aims-the treatment of mentally ill offenders and the isolation of the perpetrators to ensure public safety. It is essential to ensure that any periods of liberty deprivation do not last longer than necessary to provide appropriate treatment. Therefore, identifying the factors affecting the length of stay (LoS) is one of the most important research areas in the forensic psychiatry. The literature on this subject is scarce and to date there no data available on LoS for patients in Eastern or Central European patients. Methods: We conducted a retrospective analysis of data for 150 inpatients in a medium secure unit. Based on a literature review and clinical experience, variables potentially influencing LoS were identified and included in the analysis. Results: The variables that were significantly associated with LoS included duration of mental illness; severity of index offense; whether a crime was committed as a result of hallucinations or during drug treatment discontinuation; if the index offenses was a continuous crime (crimes committed over an extended period of time); persistent psychosis; multiple antipsychotic treatments; as well as a diagnosis of schizophrenia and schizoaffective disorder. Conclusions: Our findings are highly consistent with observations made by other researchers. However, contrary the majority of previous studies our project incorporates data concerning the clinical presentation of patients. For example, we demonstrate that variables measuring treatment resistance might be one of the crucial determinants of LoS, which is a novel research finding.

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“…Solid data, international evidence or essential knowledge from this sector is lacking, however. There are only a few studies on these issues available from the past, that covered only a small number of selected countries (5)(6)(7)(8)(9). These studies more or less used similar methods for assessing bed-rates or other data as applied in this study here, either by expert rating or by referring to administrative data, which usually turned out to be scarcely available, incomplete or of limited validity and reliability.…”

Section: Introductionmentioning

confidence: 99%

Highly varying concepts and capacities of forensic mental health services across the European Union

Salize

Dreßing

Fangerau

et al. 2023

Front. Public Health

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IntroductionThere is wide variation in the processes, structures and treatment models for dealing with mentally disordered offenders across the European Union. There is a serious lack of data on population levels of need, national service capacities, or treatment outcome. This prevents us from comparing the different management and treatment approaches internationally and from identifying models of good practice and indeed what represents financial efficiency, in a sector that is universally needed.MethodsFrom March 2019 till January 2020 we surveyed forensic psychiatric experts from each European Union Member State on basic concepts, service capacities and indicators for the prevalence and incidence of various forensic psychiatric system components. Each expert completed a detailed questionnaire for their respective country using the best available data.ResultsFinally, 22 EU Member States and Switzerland participated in the survey. Due to the frequent lack of a clear definition of what represented a forensic psychiatric bed, exact numbers on bed availability across specialized forensic hospitals or wards, general psychiatric hospitals or prison medical wards were often unknown or could only be estimated in a number of countries. Population-based rates calculated from the survey data suggested a highly variable pattern of forensic psychiatric provision across Europe, ranging from 0.9 forensic psychiatric beds per 100,000 population in Italy to 23.3 in Belgium. Other key service characteristics were similarly heterogeneous.DiscussionOur results show that systems for detaining and treating mentally disordered offenders are highly diverse across European Union Member States. Systems appear to have been designed and reformed with insufficient evidence. Service designers, managers and health care planners in this field lack the most basic of information to describe their systems and analyse their outcomes. As a basic, minimum standardized national reporting systems must be implemented to inform regular EU wide forensic psychiatry reports as a prerequisite to allow the evaluation and comparison of the various systems to identify models of best practice, effectiveness and efficiency.

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External factors influencing length of stay in forensic services – a European evaluation

Cited by 15 publications

References 21 publications

Factors Affecting Length of Inpatient Forensic Stay: Retrospective Study From Czechia

Factors Affecting Length of Inpatient Forensic Stay: Retrospective Study From Czechia

Factors Influencing Length of Stay of Forensic Patients: Impact of Clinical and Psychosocial Variables in Medium Secure Setting

Highly varying concepts and capacities of forensic mental health services across the European Union

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