Absconding of patients from an independent UK psychiatric hospital: a 3-year retrospective analysis of events and characteristics of absconders

A comparison of inpatient suicides in Australian psychiatric and non-psychiatric hospital units between 2009 and 2018

Hospitalisation is designed to protect patients from harm; however, patients have been reported to take their own lives during hospital admissions. While a significant healthcare concern, few studies have analysed inpatient suicides in general and psychiatric hospital units. Understanding these deaths is important for informing future prevention initiatives. Here we investigate a national sample (n = 367) of inpatient suicides in general (24%, n = 87) and psychiatric (76%, n = 278) hospital units. Patient characteristics, suicide location, timing, and suicide methods were assessed and compared. Patients who died from suicide were mostly male and admitted into psychiatric units. General hospital patients were less likely to have a known history of mental illness or previous self-harm and were often admitted for mental illness-related presentations. Suicides frequently occurred outside of the hospital by hanging. Patients in psychiatric units were more likely to be on approved leave at their death, and general patients were more likely to have absconded. These results indicate the need to identify risk factors relevant to each setting and address broader system-level factors. Removing obvious ligature points, preventing absconding, and assessing patients before episodes of leave, could contribute to preventing inpatient suicides.

Prevalence and Risk Factors for Absconding from an Open-Door, No-Restraint Inpatient Psychiatric Unit: A Single-Center Study in Italy

Absconding from inpatient psychiatric services has been associated with poor outcomes, putting the patient and community at risk and prolonging the recovery process. A retrospective study investigated the absconding rates and risk factors among patients admitted to an open-door, no-restraint inpatient psychiatric unit. Overall, the absconding rate was 4.5%, and the relative risk of absconding was higher for male, younger, and non-Caucasian patients as well as for those who had already absconded, were unknown to health services, compulsorily admitted, admitted for substance abuse, and in the first days of hospitalization. The findings of this study may have important public health implications.

['Anti-fugue' plant device, an innovative concept in gerontology]

Plant features represent a modality of outdoor architecture that can be integrated into a project to take into account the particularities of patients and residents, and in particular those with cognitive disorders and risks of running away. The concept of a "plant-based security system" is an innovative and transposable prevention approach that reconciles the constitutional right to freedom of movement and security. A living concept illustrated by the Seilleraye EHPAD in Carquefou.

The reasons why patients abscond from public hospitals in southeastern Iran: a qualitative study

BACKGROUND

Patient absconding from hospital is one of the permanent issues the hospitals face, which poses many risks and challenges to the patient, hospital, and society. The present study aimed to identify the reasons for patient absconding behavior for public hospitals in southeastern Iran.

METHODS

The present study is a qualitative study which was conducted at three public hospitals in southeastern Iran using purposive sampling through semi-structured interviews with 63 informants involved in patient treatment process. Data were analyzed using Colaizzi content analysis (CCA) method.

RESULTS

Three main themes of economic, social factors, and factors related to the hospital covering 15 subthemes were identified to explain the reasons for patients absconding behavior.

CONCLUSION

There are many reasons for reducing patients absconding from hospitals, and one of the main reasons is the patients' economic and social problems. The absconding behavior can lead to harm and problems for patients, and some emotional and occupational consequences for the employees and nurses. Paying attention to this issue and considering some courses of action to prevent patient absconding might lead to a considerable promotion of public trust and eliminate many problems for hospitals.

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

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.

Absconding During Inpatient Care from a Tertiary Psychiatric Hospital: A Comparative Study

BACKGROUND

Absconding from psychiatric hospitals is of great concern for patients and caregivers. Absconding affects not only the treatment and safety of these patients but also patient's caregivers and the community. Further investigation is needed to examine the pattern of this event and the characteristics of patients who abscond. Hence, our study was aimed to examine the sociodemographic and clinical profiles of inpatients who absconded from a psychiatric hospital in five years and to compare them with matched controls.

METHODS

A retrospective chart review of inpatients who absconded and matched control inpatients during the specified period of five years from January 2014 to December 2018 was done at a psychiatric hospital. Each control was matched with a corresponding absconding case on the following order: (a) admission ward, (b) admission period, (c) diagnosis, and (d) age. Results: Among 20,052 adult admissions during the specified period, 38 patients absconded, with a rate of 1.8 per 1,000 admissions. Most of them were male, from a younger age group, diagnosed with schizophrenia or mood disorder, and having comorbid substance use disorder, irritable affect, impaired judgment, and absent insight. Most of the events occurred within the first two weeks of admission. About 11% of them had a history of prior absconding from the hospital.

CONCLUSION

Knowledge about the associated sociodemographic and clinical profile would help clinicians and mental health care professionals to prevent absconding. Further risk assessment using a patient's profile would help to reduce absconding events from psychiatric hospitals in the future.

Risky Business? A Year-Long Study of Adult Voluntary Admissions Who Leave Psychiatric in-Patient Care without Informing Staff

Patients leaving inpatient psychiatric care without informing staff can have serious consequences for patient welfare, their families and staff. Even in cases where there are no serious outcomes and patients return, treatment can be interrupted and staff morale compromised. Given these potential deleterious effects, it is important to have an in-depth understanding of why people leave when they do. The aim of this study is to examine the profile of service-users who leave in-patient psychiatric care without notifying staff and to determine their reasons for doing so, what they did when they left the hospital setting and reasons for returning. This is a prospective descriptive study of service users leaving without notifying staff from a national mental health service in Ireland. It investigated the frequency, timing, and motivations of these absconding events among a sample of in-patients over a 12-month period. This year-long review identified 75 episodes of leaving without notifying staff, 55 of which met this studies criteria. 22% of episodes were from a locked unit, 58.2% were repeated episodes. 89% of service users returned to hospital following the episode and 11% were discharged against medical advice. Although no fatalities, three service users were seen in an emergency department as a result of activity during leave. Upon return from leave, all service users were reviewed and their care plans were updated where necessary.

Profiling Absconders from Public and Private Inpatient Psychiatric Units: a Comparative Analysis

Research related to absconding and its associated risks is limited in relation to inpatients from private psychiatric units. This study aimed to compare patients who abscond from public and private psychiatric inpatient settings. Demographic data was collated on the subjects (n = 214) who all had a history of absconding. Public absconders (n = 159) were more likely to have a psychotic illness, increased number of psychiatric diagnoses, history of aggression, substance use and homelessness, when compared to private absconders. Predictors identified for private absconders (n = 55) were female gender and fewer drugs used. This study has implications for the different profiles of absconders between the public and private settings.

Seeking freedom: A systematic review and thematic synthesis of the literature on patients' experience of absconding from hospital

WHAT IS KNOWN ON THE SUBJECT?: Absconding refers to patients leaving psychiatric hospitals in an unexpected and/or unauthorized way and is often recognized as a form of challenging behaviour. There is some research about the rates of absconding, risks associated with it and interventions to try and reduce it; however, relatively little is known about the experience from the perspective of patients and this evidence has not previously been systematically reviewed. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Patients abscond to find relief, to regain power and control over their lives and/or to address unmet needs. Absconding can therefore be viewed as a means of seeking freedom. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses need to be aware that absconding is a positive act from the patient perspective and work collaboratively with them to reduce factors which motivate this behaviour. From the point of admission, nurses have an important role to play in reducing the sense of fear, isolation and powerlessness which motivates patients to abscond. Practical interventions such as giving patients the time and information necessary to be involved in decision-making, or asking about their responsibilities and commitments outside of hospital, may have a significant impact on the experience of admission and reduce the risk of absconding. Abstract Introduction Absconding from psychiatric hospitals is associated with significant risks, but is difficult to assess. It is often considered a form of challenging behaviour for mental health nurses, yet there is little evidence considering the behaviour from the patient perspective. Aim To identify and review evidence pertaining to the experience of patients who abscond from hospital, paying particular attention to their reasons for doing so. Method A systematic review and thematic synthesis of eight peer-reviewed studies. Results The meaning patients associated with absconding is best characterized as an act of seeking freedom. Within this, four sub-themes were identified: 1) seeking freedom to find relief, 2) to regain power and control over their lives, 3) to address unmet needs and 4) opportunistically. Discussion Perspectives on absconding are markedly different between nurses and patients. Nurses may view absconding as challenging or deviant behaviour, whilst patients understand it as a positive experience. This is because the hospital environment is not meeting their needs. Implications for practice Patients decide to abscond from hospital for valid and rational reasons. Mental health nurses are in a position to understand and address the issues underpinning them with a view to reducing absconding. Further research on absconding from hospital, taking the patient's perspective, is needed.

Prevalence and Clinical and Coercion Characteristics of Patients who Abscond during Inpatient Care from Psychiatric Hospital

BACKGROUND

Patients absconding from psychiatric hospitals pose a serious concern for the safety of patients and public alike. Absconding is associated with an increased risk of suicide, self-harm, homicide, and becoming "missing" from society. There are only scarce data on profile and outcome of the absconding patients in India.

AIMS

To study the prevalence and describe the clinical and coercion characteristics of patients who abscond during inpatient care from an open ward.

METHODOLOGY

"Absconding" was defined as patients being absent from the hospital for a period of more than 24 h. This is an analysis of absconding patients out of the 200 admitted patients at a tertiary psychiatric hospital. Descriptive statistic was used to analyze the demographic, clinical, and perceived coercion profile and outcome.

RESULTS

The absconding rate was 4.5 incidents per 100 admissions. Most of these patients were males, from a nuclear family, admitted involuntarily, belonging to lower socio-economic status, diagnosed with schizophrenia or mood disorder with comorbid substance use disorder and had absent insight. The MacArthur Perceived Coercion Scale score was 4.58 (±1.44), and 80% of the absconded patients felt subjective coercive experiences in most domains at admission. Out of the 9 absconded patients, 2 patients had completed suicides and one continued to remain untraceable.

CONCLUSION

The absconded patients were males; admitted involuntarily; diagnosed with schizophrenia, mood disorder, and comorbid substance use disorder; and had absent insight and high perceived coercion. Absconding patients had the tendency to harm themselves and wander away from home.

The Mental Health Acts 1983 and 2007 and the offender-patient who absconds from hospital

Absconding from mental hospitals is a topic worth investigating because absconding usually has a variety of adverse consequences, not only for the absconders but also for the public and so forth. From a medical perspective, there have been several studies of absconding by mental patients and the harm they cause to themselves and others while they are at large. However, there is a paucity of such studies from a purely legal perspective. This study aims to contribute to the literature from a legal perspective by focusing on the offender-patient who absconds from hospital. It is argued, inter alia, that given the various ramifications of absconding from hospital, it is unsatisfactory that some offender-patients (specifically those on a hospital order without restrictions; s37 of the Mental Health Act 1983) could only be retaken within 28 days when they abscond from hospital, whereas non-offender patients in hospital under s3 of the same Act could be retaken within six months at least. Recommendations for reform of the law are duly tendered.

Critical Incidents During Leave From an Australian Security Hospital - A 12 Year Audit

All critical incidents between 2003 and 2015 relating to leave episodes from the High Security Inpatient Services, Brisbane, Australia were audited. The audit found that since March 2003, when the High Security Inpatient Service opened, there was a very small number of critical incidents related to over 46,000 leave episodes. Of the 17 patients who went absent without permission over the 12-year study period, only 2 patients re-offended and 1 patient deliberately self-harmed during a leave episode. One patient assaulted his escort nurse during a leave and four patients attempted unsuccessfully to flee their escort nurses during escorted off-ground leave. No patient committed a serious violent offence and no patient committed suicide during an absence from leave. Only 4 of the 17 patients who went absent during leave between 2003 and 2015 remain as inpatients in the High Security Inpatient Service.

A Prospective Cohort Study of Absconsion Incidents in Forensic Psychiatric Settings: Can We Identify Those at High-Risk?

Background

Incidents of absconsion in forensic psychiatric units can have potentially serious consequences, yet surprisingly little is known about the characteristics of patients who abscond from these settings. The few previous studies conducted to date have employed retrospective designs, and no attempt has been made to develop an empirically-derived risk assessment scale. In this prospective study, we aimed to identify predictors of absconsion over a two-year period and investigate the feasibility of developing a brief risk assessment scale.

Methods

The study examined a representative sample of 135 patients treated in forensic medium- and low-secure wards. At baseline, demographic, clinical, treatment-related, and offending/behavioural factors were ascertained from electronic medical records and the treating teams. Incidents of absconsion (i.e., failure to return from leave, incidents of escape, and absconding whilst on escorted leave) were assessed at a two-year follow-up. Logistic regression analyses were used to determine the strongest predictors of absconsion which were then weighted according to their ability to discriminate absconders and non-absconders. The predictive utility of a brief risk assessment scale based on these weighted items was evaluated using receiver operator characteristics (ROC).

Results

During the two-year follow-up period, 27 patients (20%) absconded, accounting for 56 separate incidents. In multivariate analyses, four factors relating to offending and behaviour emerged as the strongest predictors of absconsion: history of sexual offending, previous absconsion, recent inpatient verbal aggression, and recent inpatient substance use. The weighted risk scale derived from these factors had moderate-to-good predictive accuracy (ROC area under the curve: 0.80; sensitivity: 067; specificity: 0.71), a high negative predictive value (0.91), but a low positive predictive value (0.34).

Conclusion

Potentially-targetable recent behaviours, such as inpatient verbal aggression and substance use, are strong predictors of absconsion in forensic settings; the absence of these factors may enable clinical teams to identify unnecessarily restricted low-risk individuals.

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

BACKGROUND

Few 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.

METHODS

Following 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.

RESULTS

Eighty-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.

CONCLUSIONS

A 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.

Substance use and violence among psychiatric inpatients

Nursing staff on psychiatric wards often attribute patient violence and aggression to substance use. This study examined incidents of alcohol and illicit drug use among acute psychiatric inpatients and associations between substance use and violence or other forms of aggression. A sample of 522 adult psychiatric inpatients was recruited from 84 acute psychiatric wards in England. Data were collected from nursing and medical records for the first 2 weeks of admission. Only a small proportion of the sample was reported to have used or been under the influence of alcohol (5%) or drugs (3%). There was no physical violence during a shift when a patient had used alcohol or drugs. Substance using patients were also no more likely than others to behave violently at any point during the study period. However, incidents of substance use were sometimes followed by verbal aggression. Beliefs that substance using patients are likely to be violent were not supported by this study, and could impact negatively on therapeutic relationships between nurses and this patient group. Future studies are needed to examine how staff intervene and interact with intoxicated patients.

Five-year review of absconding in three acute psychiatric inpatient wards in Australia

Absconding, where patients under an involuntary mental health order leave hospital without permission, can result in patient harm and emotional and professional implications for nursing staff. However, Australian data to drive nursing interventions remain sparse. The purpose of this retrospective study was to investigate absconding in three acute care wards from January 2006 to June 2010, in order to determine absconding rates, compare patients who did and did not abscond, and to examine incidents. The absconding rate was 17.22 incidents per 100 involuntary admissions (12.09% of patients), with no significant change over time. Being male, young, diagnosed with a schizophrenia or substance-use disorder, and having a longer hospital stay were predictive of absconding. Aboriginal and Torres Strait Islander patients had higher odds of absconding than Caucasian Australians. Over 25% of absconding patients did so multiple times. Patients absconded early in admission. More incidents occurred earlier in the year, during summer and autumn, and later in the week, and few incidents occurred early in the morning. Almost 60% of incidents lasted ≤24 hours. Formulation of prospective interventions considering population demographic factors and person-specific concerns are required for evidence-based nursing management of the risks of absconding and effective incident handling when they do occur.

Predictors of length of stay in forensic psychiatry: the influence of perceived risk of violence

This study describes the prevalence of adverse events and length of stay in forensic psychiatric patients with and without a restriction order. Detailed clinical and administrative information from medical records and written court decisions was gathered retrospectively from admission until discharge for a Swedish population-based, consecutive cohort of forensic psychiatric patients (n=125). The median length of stay for the whole cohort was 951 days, but patients with a restriction order stayed in hospital almost five times as long as patients without. Restriction orders were related to convictions for violent crime, but not for any other differences in demographic or clinical variables. The majority of the patients (60%) were involved in adverse events (violence, threats, substance abuse, or absconding) at some time during their treatment. Patients with restriction orders were overrepresented in violent and threat events. Previous contact with child and adolescence psychiatric services, current violent index crime, psychotic disorders, a history of substance, and absconding during treatment predicted longer length of stay. Being a parent, high current Global Assessment of Functioning scores, and mood disorders were all significantly related to earlier discharge. In a stepwise Cox regression analysis current violent index crime and absconding remained risk factors for a longer hospital stay, while a diagnosis of mood disorder was significantly related to a shorter length of stay.

Police officers' views of absconding from mental health units in Victoria, Australia

Patients regularly abscond from mental health units and at times the consequences for patients and for others can be serious. The police are involved with absconding events, but are rarely considered in the mental health literature. In most jurisdictions, the police can take missing person reports for involuntary patients whose whereabouts are unknown and there are genuine concerns for their safety or welfare. Those people remain active cases for the police until located. This paper presents extracts of 25 police officers' narratives from a qualitative research project. Officers viewed absconding as a regular event, and workload burden that was exacerbated when mental health staff rarely initiated any search for the absconded patient and abdicated responsibility too quickly to the police. The officers were concerned about communication with mental health services and reported that information about the absconded patient could be inadequate or not given to police, and police often were not informed when the patient was found or discharged. Improved liaison and cooperative working that promote effective communication could strengthen police and mental health nursing collaboration and ensure better outcomes for patients.

Characteristics and motivations of absconders from forensic mental health services: a case-control study

BACKGROUND

Absconding from hospital is a significant health and security issue within psychiatric facilities that can have considerable adverse effects on patients, their family members and care providers, as well as the wider community. Several studies have documented correlates associated with absconding events among general psychiatric samples; however, few studies have examined this phenomenon within samples of forensic patients where the perception of threat to public safety in the event of an unauthorized absence from hospital is often higher.

METHODS

We investigate the frequency, timing, and determinants of absconding events among a sample of forensic psychiatric patients over a 24-month period, and compare patients who abscond to a control group matched along several sociodemographic and clinical dimensions. We explore, in a qualitative manner, patients' motives for absconding.

RESULTS

Fifty-seven patients were responsible for 102 incidents of absconding during the two year study window. Forensic patients who absconded from hospital were more likely to have a history of absconding attempts, a diagnosed substance use disorder, as well as score higher on a structured professional violence risk assessment measure. Only one of the absconding events identified included an incident of minor violence, and very few included the commission of other illegal behaviors (with the exception of substance use). The most common reported motive for absconding was a sense of boredom or frustration.

CONCLUSIONS

Using an inclusive definition of absconding, we found that absconding events were generally of brief duration, and that no member of the public was harmed by patients who absconded. Findings surrounding the motivations of absconders suggest that improvements in therapeutic communication between patients and clinical teams could help to reduce the occurrence of absconding events.

Psychiatric elopement: using evidence to examine causative factors and preventative measures

BACKGROUND

Elopement is a problem in the inpatient mental health community. Elopement can have serious and long term effects for the patients and staff.

OBJECTIVE

The purposes of this paper are to present a review of the literature regarding elopement and to provide recommendation for practice.

DESIGN

Using several databases, a search of the existing literature was conducted.

RESULTS

Elopement occurs due to a number of factors, including: psychosocial issues, staff-patient interaction, the patient's attitude toward hospitalization, and their mental illness.

CONCLUSION

It is important to understand why patients seek to elope from treatment facilities to prevent further occurrences.

The profile of absconding psychiatric inpatients in Australia

AIMS AND OBJECTIVES

The purpose of this study was to examine absconding behaviour (a patient leaving the hospital without permission) in acute and rehabilitation wards of one Australian psychiatric institution to describe the characteristics of the absconding patient and these events.

BACKGROUND

Absconding is a significant issue in psychiatric inpatient settings, with risks that include patient harm, aggression and violence. In spite of this, limited research has been conducted in Australia on patients who abscond while receiving psychiatric care.

DESIGN

The study was a retrospective descriptive analysis.

METHOD

Absconding events from three acute and seven rehabilitation wards over a 12-month period were studied.

RESULTS

The rate of absconding events by detained patients was 20.82%. Gender was not significantly associated with absconding, although 61.19% of those who absconded were men diagnosed with schizophrenic disorders. Over half of acute care patients who absconded left during their first 21-day detention order. More than half of absconding events were by patients that absconded more than once. There was limited support for the efficacy of locking ward doors. Age and diagnosis emerged as particularly important factors to consider.

DISCUSSION

The study revealed that men are not more likely to abscond than women, that locking ward doors does not deter the determined absconders and that once a person has absconded, they are more likely to do so again. Younger patients and those with a schizophrenic disorder may be particularly likely to abscond. There also appears to be a link between continuing detention orders and an absconding event.

CONCLUSIONS

Findings provide new data about the profile of absconding patients in Australia. Exploration of the reasons why patients abscond and why many do so repeatedly warrants further investigation.

RELEVANCE TO CLINICAL PRACTICE

Risk management approaches taking into account factors associated with absconding could be trialled to reduce the incidence of absconding in psychiatric inpatient settings.

Retrospective analysis of absconding behaviour by acute care consumers in one psychiatric hospital campus in Australia

Absconding is increasingly being recognized as a problem within mental health settings with significant risks for consumers. This study examines absconding behaviours across three acute care wards within an Australian psychiatric hospital campus over a 12-month period. A descriptive statistical analysis determined the rate of absconding from 49 consumers who absconded 64 times. The absconding rate was 13.33% (absconding events), with most absconding events arising from males diagnosed with schizophrenia (57.14%) aged between 20 and 29 years, and with 62.50% of absconding events occurring whilst consumers were on their first 21-day detention order. Nearly half of all absconding events were by consumers who had absconded previously, with the highest proportion of events occurring during nursing handover. A profile of people who abscond, time of day of absconding, legal status and repeated absconding behaviours are described. The emergent profile of consumers who absconded within this study bears some similarities to that described in overseas research, although in this study consumers were slightly older and 25% of absconders were female. Of particular interest are findings that identify the timings of absconding events in relation to a consumer's legal status. Implications for practice, including assessment of risk of absconding and management, are considered.

Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey

BACKGROUND

Suicide prevention by mental health services requires an awareness of the antecedents of suicide amongst high risk groups such as psychiatric in-patients. The goal of this study was to describe the social and clinical characteristics of people who had absconded from an in-patient psychiatric ward prior to suicide, including aspects of the clinical care they received.

METHODS

We carried out a national clinical survey based on a 10-year (1997-2006) sample of people in England and Wales who had died by suicide. Detailed data were collected on those who had been in contact with mental health services in the year before death.

RESULTS

There were 1,851 cases of suicide by current psychiatric in-patients, 14% of all patient suicides. 1,292 (70%) occurred off the ward. Four hundred and sixty-nine of these patients died after absconding from the ward, representing 25% of all in-patient suicides and 38% of those that occurred off the ward. Absconding suicides were characterised by being young, unemployed and homeless compared to those who were off the ward with staff agreement. Schizophrenia was the most common diagnosis, and rates of previous violence and substance misuse were high. Absconders were proportionally more likely than in-patients on agreed leave to have been legally detained for treatment, non-compliant with medication, and to have died in the first week of admission. Whilst absconding patients were significantly more likely to have been under a high level of observation, clinicians reported more problems in observation due to either the ward design or other patients on the ward.

CONCLUSION

Measures that may prevent absconding and subsequent suicide amongst in-patients might include tighter control of ward exits, and more intensive observation of patients, particularly in the early days of admission. Improving the ward environment to provide a supportive and less intimidating experience may contribute to reduced risk.

Absconding: A review of the literature 1996-2008

Absconding is a significant problem with potential for harm to patients or the general public. The consequences of absconding include physical harm, prolonged treatment time, and substantial economic costs. The aim of this systematic literature review is to synthesize quality literature about absconding from psychiatric facilities, identify gaps in knowledge, and make recommendations for practice. An electronic search yielded 39 journal articles that met the review criteria. Findings demonstrate that a single definition of absconding remains elusive, making the prevalence of absconding difficult to establish. Absconding events are multifactorial, with environmental, psychosocial, and organic aspects. Negative consequences exist including violence, aggression, and self-neglect and harm to self and others. Papers are clustered around the following themes: harm and risk, absconder profiles, absconding rates, and perceptions of nurses and patients. Nursing interventions designed to decrease absconding have been implemented with success, but only in a few studies and in Australia, none have been reported in the literature to date. Further research is required to identify appropriate nursing-based interventions that may prove useful in reducing the risk of absconding.

Differences in dropout between diagnoses in child and adolescent mental health services

Dropout from treatment is a significant problem in child and adolescent mental health services, and findings regarding the role of possible contributing factors are inconsistent. It is argued that this inconsistency may be the result of the confounding effects of different definitions of dropout, and different dropout rates for different diagnoses. A file review of 520 new cases over a 12-month period in a large Child and Adolescent Mental Health Service in Melbourne, Australia was performed. Information was collected about the intake, parents, family, child, diagnoses and treatment. A significant relationship was found between diagnosis and dropout rate, with clients experiencing family problems or conduct disorder and ADHD being more likely to dropout, and those experiencing negative life events, anxiety disorders or those not having a diagnosis being less likely to dropout. These findings offer potential directions for services to consider specific strategies for retaining their clients. Possible reasons for these findings, methodological issues and future research directions are discussed.

A prospective study of patients absconding from a general hospital psychiatry unit in a developing country

Characteristics of patients absconding from an open psychiatry ward in a developing country may be different from both those in developed countries and a mental hospital setting. The aim of this paper is to study the incidence and characteristics of patients absconding from an open psychiatric ward in a general hospital-based psychiatric unit in India. We studied patients consecutively admitted to an open psychiatric ward over a 2-month period. We compared those who absconded with those who did not. Out of 231 patients admitted, 33 absconded. Among those who absconded, 15 had bipolar disorder, 11 had schizophrenia and five had substance-related disorders. Nine had indicated their intention to do so at admission. Ten patients had absconded by the second day. The treatment cost was the likely influencing factor for seven patients who absconded after deemed fit for discharge on clinical grounds. Only 10 patients were readmitted to the hospital within 2 weeks of absconding. The risk of absconding is highest in the early days following. Absconding patients did not differ significantly from others in many socio-demographic and clinical features. Treatment costs are an important consideration in India.