Factors Affecting Length of Stay on Maximum Security in a Forensic Psychiatric Hospital

Abstract

Forensic hospitals are responsible for both the custody and treatment of patients, including treatment that will minimize the risk of future violence to the community. This study examined factors that affected length of stay (LOS) in Maryland’s only maximum-security forensic hospital for mentally ill patients who were adjudicated not criminally responsible (NCR) for serious violent crimes. The current study focused on the combined effects of demo-graphic, legal, and clinical variables on LOS in NCR patients who had been approved for transfer to a less restrictive environment to determine what, if any, variables should be targeted for services during hospitalization. The results of the study indicated that, in addition to gender, history of employment prior to the offense was the strongest predictor of LOS. Three other variables contributed less significantly to the prediction model. These findings have pro-grammatic implications for forensic psychiatric facilities treating the seriously mentally ill.

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

“…Several factors can have an impact on LOS, such as a country's jurisdiction, changes in criminal justice policy (Grove, MacLeod, & Godfrey, 1998), changes in the organization of a country's mental health system (Sharma et al, 2015), and patient characteristics (Davoren et al, 2015;Dumont et al, 2012;Moran, Fragala, Wise, & Novak, 1999;Shah et al, 2011).…”

“…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.…”

“…The sole sociodemographic factor which has been found to be related to a longer LOS was being male (Davoren et al, 2015). Legal factors Downloaded by [92.108.141.14] at 01:24 03 January 2018 that were found to be related to a longer LOS were a history of absconding (Andreasson et al, 2014), a need to prevent absconding, public confidence, victim sensitivity, legal process (Davoren et al, 2015), a younger age at index offense (Moran et al, 1999), and a younger age at the first documented delinquency (Ross et al, 2012). Clinical factors linked to a longer LOS were previous psychiatric admissions (Ross et al, 2012;Shah et al, 2011), previous contact with child and adolescent psychiatric services (Andreasson et al, 2014), having a lifetime diagnosis of learning disability, having severe mental illness as diagnosis, making less progress in rehabilitation measured three months prior to the conducted study (O'Neill et al, 2003), persistence of mental state associated with violence, specialist forensic treatment need, complex risk of violence (comorbidity), problematic institutional behavior (Davoren et al, 2015), and a higher baseline risk of recidivism (Lammers et al, 2014) as measured with the HCR-20 historical factors (Webster, Douglas, Eaves, & Hart, 1997).…”

“…Sociodemographic factors associated with a shorter LOS included being a parent (Andreasson et al, 2014), a longer history of employment prior to admission (Moran et al, 1999;Ross et al, 2012) and higher level of school qualification and professional achievements (Ross et al, 2012). Clinical factors found to be related to a shorter LOS were a diagnosis of an affective disorder (Andreasson et al, 2014;Shah et al, 2011), a higher Global Assessment of Function score (American Psychiatric Association [APA], 2000; Andreasson et al, 2014), less severe violent behavior during admission at the forensic hospital (Ross et al, 2012), not being secluded (Davoren et al, 2015) and having an adjustment disorder as primary diagnosis (Davoren et al, 2015).…”

“…Studies in Sweden (Andreasson et al, 2014), Ireland (Davoren et al, 2015;O'Neill et al, 2003), Germany (Ross et al, 2012), and the US (Moran et al, 1999) concluded that a more serious index offense was related to longer LOS, whereas in the UK (Shah et al, 2011) a severe index offense was associated with a shorter LOS. In a study from Ireland (O'Neill et al, 2003), substance abuse problems were associated with a shorter LOS, whereas in Sweden, Andreasson et al (2014) found that substance abuse problems were associated with longer LOS, while in the UK no relationship was found between substance abuse and LOS (Shah et al, 2011).…”