Factors influencing treatment team recommendations to review tribunals for forensic psychiatric patients

Abstract

It is the responsibility of forensic psychiatric hospitals to detain and treat patients, gradually reintegrating them into society; decisions to release patients must balance risk to the public with maintaining the least restrictive environment for patients. Little is known about the factors considered when making such decisions and whether these factors have been empirically linked to future risk of violence. The current study explores the factors predictive of forensic treatment teams' recommendations for patients under the care of the Ontario Review Board (ORB). Factors differ depending on level of security; decisions on medium secure units were influenced by the presence of active symptoms and patients' overall violence risk level and decisions made on minimum secure units were influenced by the number of critical incidents that occurred within the recommendation year. Understanding the factors used to make recommendations to the ORB tribunal helps treatment teams to reflect on their own decision-making practices. Furthermore, the results serve to inform us about factors that influence length of stay for forensic psychiatric patients. Copyright © 2016 John Wiley & Sons, Ltd.

Factors And Predictors Of Length Of Stay In Offenders Diagnosed With Schizophrenia- A Machine-learning-based Approach

“…These will be summarized in the remainder of this section along with frequently confirmed prior findings since they have informed the primary set of variables explored in the present study (also see Table 1 for a summary). Past researchers studied patients from different security settings (25)(26)(27) or regardless of their moving (or not moving) from one level of security to another (1,15,16,28,29). In some research, factors which were found to be relevant to patients' transfer from a medium to a minimum security setting were set equal to those relevant to patients' discharge into the community, and vice versa (27).…”

“…There is also some evidence that emotional neglect during childhood has a prolonging effect (7). Socio-demographic variables associated with a reduction of time spent in inpatient treatment included being a parent (1), good contact with one's family or good social support (26)(27)(28), and living in a close relationship (16). While some studies reported prolonged inpatient treatment for certain religious minorities (28) and patients having migrated (7), others reported shorter length of stay for immigrants (16) and ethnic minorities (17).…”

“…In terms of forensic treatment variables, adverse behaviours and events such as violence, substance abuse, absconding, non-compliance, requirement of seclusion, physical restraints, forced medication, or conditional release failure significantly delayed discharge (1,3,16,26,27,31,33,35,38,42).…”

“…Patients who stayed hospitalised for a shorter period of time were more likely to make good therapeutic progress (15,26), participate in more therapy programmes (26), work in the hospital (28), reside in open wards, had higher levels of ground privileges, were involved in community, educational, or vocational activities (42), participated in activities in general (27), were more likely to be cooperative (29), expressed remorse for their crime(s), and had positive references (35).…”

“…Variables explored in this and prior research on length of stay ,6,15,16,26,27,30,34,42) marital status at time of index offence dichotomous (married, single)(5, 6, 15, 16, 26-28, 31, 35) …”