The impact of structured decision making on absconding by forensic psychiatric patients: results from an A-B design study

Abstract

BackgroundFew studies have investigated absconding from forensic hospitals and there are no published studies of interventions aimed at reducing these incidents in forensic settings. We present a study of the impact of a new policy using structured professional judgment and an interdisciplinary team-based approach to granting privileges to forensic patients. We assess the impact of this policy on the rate and type of absconding from a metropolitan forensic facility.MethodsFollowing concern about the rate of absconding at our hospital, a new policy was implemented to guide the process of granting hospital grounds and community access privileges. Employing an A-B design, we investigated the rate, characteristics, and motivations of absconding events in the 18 months prior to, and 18 months following, implementation of this policy to assess its effectiveness.ResultsEighty-six patients were responsible for 188 incidents of absconding during the 42-month study window. The rate of absconding decreased progressively from 17.8% of all patients at risk prior to implementation of the new policy, to 13.8% during implementation, and further to 12.0% following implementation. There was a differential impact of the policy on absconding events, in that the greatest reduction was witnessed in absconsions occurring from unaccompanied passes; this was offset, to some extent, by an increase in absconding occurring from within hospital units or from staff accompanied outings. Seven of the absconding events included incidents of minor violence, and two included the commission of other illegal behaviors. The most common reported motive for absconding across the time periods studied was a sense of boredom or frustration. Discharge rate from hospital was 22.9% prior to the implementation of the policy to 22.7% after its introduction, indicating no change in the rate of patients’ eventual community reintegration.ConclusionsA structured and team-based approach to decision making regarding hospital grounds and community access privileges appeared to reduce the overall rate of absconding without slowing community reintegration of forensic patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0474-1) contains supplementary material, which is available to authorized users.

Patient Absconding and Its Predictors: A 5-Year Retrospective Analysis in a General Teaching Hospital in Tehran, Iran

“…The causes of patient absconding include fear, homesickness, irritation, concerns about family responsibilities, delayed medical examinations and treatments, treatment costs, lack of insurance coverage, lack of information about the disease, and mental disorders (3,15,(17)(18)(19). According to a study by Handel et al, reducing the waiting time for patients and informing them about the approximate waiting time can dissipate the number of escapes (20).…”

Patient safety in inpatient mental health settings: a systematic review

“…Three explored the patient experience of absconding, specifically relating to patient perspectives of treatment and involuntary commitment 357–359. One study explored staff perspectives of absconding management techniques,360 and two studies evaluated interventions to reduce absconding rates; both were found to be effective 361 362. Two studies focused on wandering behaviour in women with dementia, linking wandering to physical environment factors, such as light, sound, crowding363 and falls 364.…”

Perspective On Excellence in Forensic Mental Health Services: What We Can Learn From Oncology and Other Medical Services

“…At Level 2, consistency applies only within teams with some consistency through the use of international diagnostic systems and manualized treatment programs. At Level 3, hospital or service-wide governance is applied to essential decision making and processes such as applying admission criteria by admission panels (65–69), to plan care pathways across the service, with evidence-based decision making on matters such as care systems (70–73), leave (74, 75), and reports to mental health review tribunals (76–78). At Level 3, precision medicine can be practiced with diagnosis refined into the staging of progression of illnesses and outcomes (79).…”