1
|
Absconsion in forensic psychiatric services: a systematic review of literature. CNS Spectr 2022; 27:46-57. [PMID: 33023708 DOI: 10.1017/s1092852920001881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
While serious concerns are often raised when patients abscond or leave unauthorized from psychiatric services, there is limited knowledge about absconsion in forensic psychiatric services. Following the preferred reporting items for systematic reviews and meta-analyses guideline, we searched Medline/PubMed, PsycINFO, EMBASE, CINAHL, Scopus, and Web of Science through May 2020 for eligible reports on absconsion in forensic patients with no language limits. The search string combined terms for absconsion, forensic patients, and psychiatry in various permutations. This was supplemented by snowball searching for additional studies. Of the 565 articles screened, 25 eligible studies, including two interventional, seven cross-sectional, and 16 case-controlled studies spanning five decades were included. Absconsion and re-absconsion rates ranged from 0.2% to 54.4% and 15% to 71%, respectively, albeit higher rates trended with less secure psychiatric units. Previous absconsion, aggression, substance use, high Historical Clinical Risk Management-20 score, anti-sociality, psychiatric symptoms, sexual offending, and poor treatment adherence were the factors reported with a degree of predictive value for absconsion. However, the construct of absconsion was heterogeneous in the included studies and the quality of evidence on the predictors of absconsion was limited. Serious risky behaviors including re-offending, violence, self-harm, suicide, rape, and manslaughter were perpetrated by patients during unauthorized leave. Nevertheless, the rates of re-offending were generally low in the included studies (highest recidivism rate = 0.11). There is need for standardized assessment and documentation of absconsion to improve risk analysis and management. Furthermore, it is necessary to develop a structured guideline for defining absconsion, and to create a protocol that operationalizes all absconsion-related behaviors/events to promote reliable assessment and comparative analysis in future studies.
Collapse
|
2
|
Donnelly J, Kavanagh A, Donohue G. Risky Business? A Year-Long Study of Adult Voluntary Admissions Who Leave Psychiatric in-Patient Care without Informing Staff. Issues Ment Health Nurs 2020; 41:840-845. [PMID: 32421458 DOI: 10.1080/01612840.2020.1725196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
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.
Collapse
Affiliation(s)
- Jennifer Donnelly
- Department of Nursing, St. Patrick's Mental Health Services, Dublin, Ireland
| | - Adam Kavanagh
- Department of Nursing, St. Patrick's Mental Health Services, Dublin, Ireland
| | - Gráinne Donohue
- Trinity Centre for Healthcare and Practice Innovation, School of Nursing and Midwifery, Trinity College, University of Dublin, Ireland
| |
Collapse
|
3
|
Kavanagh A, Donnelly J, Dunne N, Maher T, Nichol M, Creedon J. Factors associated with requests for premature discharge and the decision to support a service user through the discharge against medical advice process. Int J Ment Health Nurs 2020; 29:716-724. [PMID: 32134182 DOI: 10.1111/inm.12706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 11/27/2022]
Abstract
In the Irish mental healthcare system, voluntarily admitted service users can request to leave hospital at any time. Following engagement with treating clinicians, service users remain as voluntary inpatients, are discharged, discharge themselves against medical advice, or are detained under legislation for the purposes of assessment. While detention conflicts with the principle of autonomy and a human rights-based approach, premature discharge is often associated with negative outcomes including reduced time to readmission, poorer quality of life, increased costs, and suicide. This study is a retrospective review of clinical records to identify factors associated with requests for premature discharge. Considerations of clinicians making the decision to detain the person or to support them through the discharge against medical advice process were also elucidated. Data were collected from clinical records of service users who requested discharge and were subsequently discharged against medical advice or detained involuntarily. Discharge against medical advice represented 3.5% of all discharges. The most frequent reasons for requests for discharge against medical advice were dissatisfaction with treatment, lack of engagement due to addiction, and leaving without notifying staff. Requests for discharge against medical advice frequently occurred out of hours, and nurses were the clinicians most likely to receive such requests.
Collapse
Affiliation(s)
- Adam Kavanagh
- St. Patrick's Mental Health Services, Dublin 8, Ireland
| | | | - Niall Dunne
- St. Patrick's Mental Health Services, Dublin 8, Ireland
| | - Tom Maher
- St. Patrick's Mental Health Services, Dublin 8, Ireland
| | | | - John Creedon
- St. Patrick's Mental Health Services, Dublin 8, Ireland
| |
Collapse
|
4
|
Voss I, Bartlett R. Seeking freedom: A systematic review and thematic synthesis of the literature on patients' experience of absconding from hospital. J Psychiatr Ment Health Nurs 2019; 26:289-300. [PMID: 31359573 DOI: 10.1111/jpm.12551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 07/03/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022]
Abstract
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.
Collapse
Affiliation(s)
- Isobel Voss
- South West London and St George's Mental Health NHS Trust, London, UK
| | | |
Collapse
|
5
|
Fletcher J, Hamilton B, Kinner S, Sutherland G, King K, Tellez JJ, Harvey C, Brophy L. Working towards least restrictive environments in acute mental health wards in the context of locked door policy and practice. Int J Ment Health Nurs 2019; 28:538-550. [PMID: 30516024 DOI: 10.1111/inm.12559] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 11/29/2022]
Abstract
There has been a shift towards provision of mental health care in community-based settings in Australia. However, hospitals continue to care for people in acute mental health wards. An increasing proportion of the people in wards are admitted involuntarily, subject to restrictions of movement to minimize risk of harm to self and others. In response to concerns about the safety of people absconding from care, Queensland Health introduced a policy requiring all acute mental health wards in the State to be locked. In response, the Queensland Mental Health Commission funded a project to understand the impact of this policy and develop evidence-based recommendations regarding provision of least restrictive, recovery-oriented practices in acute wards. Facilitated forums were conducted with 35 purposively selected participants who identified as consumers, carers, or staff of acute mental health hospital wards, to test the acceptability, feasibility, and face validity of a set of evidence-informed recommendations for providing least restrictive, recovery-oriented practices. Participant responses were recorded, and data were analysed through an inductive, thematic approach. A recovery-oriented approach was supported by all stakeholders. Reducing boredom and increasing availability of peer support workers were considered key to achieving this. Focusing less on risk aversion was reported as central to enabling true Recovery Orientation. This project enabled recognition of the perspectives of consumers, carers, and staff in the consideration of evidence-informed recommendations that could be implemented to provide least restrictive care in the context of locked doors.
Collapse
Affiliation(s)
- Justine Fletcher
- Melbourne School of Population and Global Health, Centre for Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bridget Hamilton
- School of Health Sciences, Centre for Psychiatric Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart Kinner
- Royal Children's Hospital, Adolescent and Young Adult Health Equity Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Georgina Sutherland
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kylie King
- Melbourne School of Population and Global Health, Centre for Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Juan Jose Tellez
- Melbourne Law School, Melbourne Social Equity Institute Carlton, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carol Harvey
- Department of Psychiatry, Psychosocial Research Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Brophy
- Melbourne School of Population and Global Health, Centre for Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Mind Australia, Research, Development and Advocacy, Melbourne, Victoria, Australia.,The School of Allied Health, Latrobe University, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
The Cost of Leaving the Emergency Department without Notice; a Cross-sectional Study. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2018; 2:e6. [PMID: 31172069 PMCID: PMC6548103 DOI: 10.22114/ajem.v2i1.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Leaving the hospital without notice is among the problems that can inflict financial and non-financial burdens on the health care system of a country. Objective: The present study was carried out with the aim of evaluating the prevalence of leaving without notice cases in the emergency department (ED) of one of the major teaching hospitals of Tehran affiliated with Shahid Beheshti University of Medical Sciences and calculating the direct costs resulting from it. Methods: This study was a retrospective cross-sectional one carried out during 1 year from 2016 to 2017 in one of the teaching hospitals of Tehran affiliated with Shahid Beheshti University of Medical Sciences. Sampling was performed via census method and the study population consisted of the profiles of all the patients who had left the hospital without notice or checking out after being admitted to the hospital. To gather the required data for this study, a checklist consisting of questions regarding sex, age, insurance coverage, and the amount of money they owed the hospital was used. Statistical analysis was performed using the software IBM Statistics for Windows v22 and P-value<0.05 was considered significant. Results: Out of the total of 39946 patients visiting the ED of the studied hospital during 1 year, 1692 (4.2%) had left the hospital without checking out. Below 30 years age range was the most common age range with 46.9% (794 patients) and 72.9% of the patients leaving without notice were men. Based on the findings obtained, male patients without insurance coverage had attempted to leave the hospital without notice more than others (p<0.001). The total cost inflicted by leaving without notice throughout the studied year was 1,755,286,279 Rials, which is equal to 0.0059 of the total annual income of the ED. Conclusion: Throughout the year this study was performed, a total of 1.2% of all the visitors of the ED of a hospital affiliated with Shahid Beheshti University of Medical Sciences left the hospital without notice or checking out, which inflicted a considerable cost on the ED.
Collapse
|
7
|
Scott R, Meehan T. Critical Incidents During Leave From an Australian Security Hospital - A 12 Year Audit. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2017; 24:47-60. [PMID: 31983938 PMCID: PMC6818218 DOI: 10.1080/13218719.2016.1169572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
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.
Collapse
Affiliation(s)
- Russ Scott
- Forensic Psychiatrist, High Security Inpatient Services, The Park, Centre for Mental Health, Treatment and Research, Wacol, Brisbane, Australia
- Correspondence: Russ Scott, The Park, Centre for Mental Health, Treatment and Research, Wacol, Brisbane, Australia.
| | - Tom Meehan
- Associate Professor, Department of Psychiatry, University of Queensland, Director of Service Evaluation and Research, The Park, Centre for Mental Health, Treatment and Research, Wacol, Brisbane, Australia
| |
Collapse
|
8
|
Bowers L, James K, Quirk A, Simpson A, Stewart D, Hodsoll J. Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial. Int J Nurs Stud 2016; 52:1412-22. [PMID: 26166187 PMCID: PMC4518134 DOI: 10.1016/j.ijnurstu.2015.05.001] [Citation(s) in RCA: 199] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 04/30/2015] [Accepted: 05/03/2015] [Indexed: 11/04/2022]
Abstract
Background Acute psychiatric wards manage patients whose actions may threaten safety (conflict). Staff act to avert or minimise harm (containment). The Safewards model enabled the identification of ten interventions to reduce the frequency of both. Objective To test the efficacy of these interventions. Design A pragmatic cluster randomised controlled trial with psychiatric hospitals and wards as the units of randomisation. The main outcomes were rates of conflict and containment. Participants Staff and patients in 31 randomly chosen wards at 15 randomly chosen hospitals. Results For shifts with conflict or containment incidents, the experimental condition reduced the rate of conflict events by 15% (95% CI 5.6–23.7%) relative to the control intervention. The rate of containment events for the experimental intervention was reduced by 26.4% (95% CI 9.9–34.3%). Conclusions Simple interventions aiming to improve staff relationships with patients can reduce the frequency of conflict and containment. Trial registration IRSCTN38001825.
Collapse
Affiliation(s)
- Len Bowers
- Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Karen James
- Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
| | - Alan Quirk
- Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB, United Kingdom
| | - Alan Simpson
- City University London, Northampton Square, London EC1V 0HB, United Kingdom
| | | | - Duncan Stewart
- Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
| | - John Hodsoll
- Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom
| |
Collapse
|
9
|
Abstract
Novel technological interventions are increasingly used in mental health settings. In this article, we describe 3 novel technological strategies in use for management of risk and violence in 2 forensic psychiatry settings in the United Kingdom: electronic monitoring by GPS-based tracking devices of patients on leave from a medium secure service in London, and closed circuit television (CCTV) monitoring and motion sensor technology at Broadmoor high secure hospital. A common theme is the use of these technologies to improve the completeness and accuracy of data used by clinicians to make clinical decisions. Another common thread is that each of these strategies supports and improves current clinical approaches rather than drastically changing them. The technologies offer a broad range of benefits. These include less restrictive options for patients, improved accountability of both staff and patients, less invasive testing, improved automated record-keeping, and better assurance reporting. Services utilizing technologies need also be aware of limitations. Technologies may be seen as unduly restrictive by patients and advocates, and technical issues may reduce effectiveness. It is vital that the types of technological innovations described in this article should be subject to thorough evaluation that addresses cost effectiveness, qualitative analysis of patients' attitudes, safety, and ethical considerations.
Collapse
|
10
|
Simpson AIF, Penney SR, Fernane S, Wilkie T. The impact of structured decision making on absconding by forensic psychiatric patients: results from an A-B design study. BMC Psychiatry 2015; 15:103. [PMID: 25935745 PMCID: PMC4424885 DOI: 10.1186/s12888-015-0474-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 04/22/2015] [Indexed: 11/10/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Alexander I F Simpson
- Complex Mental Illness Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, M6J 1H4, ON, Canada. .,University of Toronto, Toronto, Canada.
| | - Stephanie R Penney
- Complex Mental Illness Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, M6J 1H4, ON, Canada. .,University of Toronto, Toronto, Canada.
| | - Stephanie Fernane
- Complex Mental Illness Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, M6J 1H4, ON, Canada.
| | - Treena Wilkie
- Complex Mental Illness Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, M6J 1H4, ON, Canada. .,University of Toronto, Toronto, Canada.
| |
Collapse
|
11
|
O’Shea LE, Picchioni MM, Dickens GL. The Predictive Validity of the Short-Term Assessment of Risk and Treatability (START) for Multiple Adverse Outcomes in a Secure Psychiatric Inpatient Setting. Assessment 2015; 23:150-62. [DOI: 10.1177/1073191115573301] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Short-Term Assessment of Risk and Treatability (START) aims to assist mental health practitioners to estimate an individual’s short-term risk for a range of adverse outcomes via structured consideration of their risk (“Vulnerabilities”) and protective factors (“Strengths”) in 20 areas. It has demonstrated predictive validity for aggression but this is less established for other outcomes. We collated START assessments for N = 200 adults in a secure mental health hospital and ascertained 3-month risk event incidence using the START Outcomes Scale. The specific risk estimates, which are the tool developers’ suggested method of overall assessment, predicted aggression, self-harm/suicidality, and victimization, and had incremental validity over the Strength and Vulnerability scales for these outcomes. The Strength scale had incremental validity over the Vulnerability scale for aggressive outcomes; therefore, consideration of protective factors had demonstrable value in their prediction. Further evidence is required to support use of the START for the full range of outcomes it aims to predict.
Collapse
Affiliation(s)
- Laura E. O’Shea
- St Andrew’s Academic Department, Northampton, UK
- King’s College London Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Marco M. Picchioni
- St Andrew’s Academic Department, Northampton, UK
- King’s College London Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Geoffrey L. Dickens
- St Andrew’s Academic Department, Northampton, UK
- Abertay University, Dundee, UK
| |
Collapse
|
12
|
Gerace A, Oster C, Mosel K, O'Kane D, Ash D, Muir-Cochrane E. Five-year review of absconding in three acute psychiatric inpatient wards in Australia. Int J Ment Health Nurs 2015; 24:28-37. [PMID: 25444670 DOI: 10.1111/inm.12100] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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.
Collapse
Affiliation(s)
- Adam Gerace
- School of Nursing & Midwifery, Flinders University of South Australia, Adelaide, South Australia, Australia
| | | | | | | | | | | |
Collapse
|
13
|
Khammarnia M, Kassani A, Amiresmaili M, Sadeghi A, Karimi Jaberi Z, Kavosi Z. Study of patients absconding behavior in a general hospital at southern region of Iran. Int J Health Policy Manag 2014; 4:137-41. [PMID: 25774367 DOI: 10.15171/ijhpm.2014.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/27/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients' escape from hospital imposes a significant cost to patients as well as the health system. Besides, for these patients, exposure to adverse events (such as suicide, self-harm, violence and harm to hospital reputation) are more likely to occur compared to others. The present study aimed to determine the characteristics of the absconding patients in a general hospital through a case-control design in Shiraz, Iran. METHODS This case-control study was conducted on 413 absconded patients as case and 413 patients as control in a large general hospital in Shiraz, southern Iran. In this study, data on the case and control patients was collected from the medical records using a standard checklist in the period of 2011-3. Then, the data were analyzed using descriptive and analytical statistics, through SPSS 16. RESULTS The finding showed that 413 patients absconded (0.50%) and mean of age in case group was 40.98 ± 16.31 years. In univariate analysis, variables of gender [Odds Ratio (OR)= 2], ward (OR= 1.22), insurance status (OR= 0.41), job status (OR= 0.34) and residence expenditure were significant. However, in multivariate analysis significant variables were age (ORadj= 0.13), gender (ORadj= 2.15), self-employment/unemployed (ORadj= 0.47), emergency/admission (ORadj= 2.14), internal/admission (ORadj= 3.16), insurance status (ORadj= 4.49) and residence expenditure (ORadj= 1.15). CONCLUSION Characteristics such as middle age, male gender, no insurance coverage, inability to afford hospital expenditures and admission in emergency department make patients more likely abscond from the hospital. Therefore, it may be necessary to focus efforts on high-risk groups and increase insurance coverage in the country to prevent absconding from hospital.
Collapse
Affiliation(s)
- Mohammad Khammarnia
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Aziz Kassani
- Prevention of Psychosocial Injuries Research Centre, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammadreza Amiresmaili
- Research Center for Health Services Management, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmad Sadeghi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Karimi Jaberi
- Research Center for Health Services Management, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. ; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Kavosi
- Department of Health Services Management, School of Management and Medical Information, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
14
|
Scott R, Goel V, Neillie D, Stedman T, Meehan T. Unauthorised absences from leave from an Australian security hospital. Australas Psychiatry 2014; 22:170-3. [PMID: 24526793 DOI: 10.1177/1039856214522529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To consider incidents relating to absences without permission from authorised leave from a security hospital. METHOD A retrospective audit over a 10-year period of all critical incidents relating to leave from the High Security Inpatient Services, Brisbane, Australia. RESULTS There has been a low incidence of patients absenting themselves without permission from leave. Of the 12 patients who went absent without permission over the 10-year study period, only one patient was reported to have committed an offence and no patient seriously self-harmed. CONCLUSIONS Attention to patient selection and risk management strategies have been effective in minimising the risk to patients and to the community as a direct result of absences without permission from authorised leave.
Collapse
Affiliation(s)
- Russ Scott
- Forensic Psychiatrist, High Security Inpatient Services, The Park - Centre for Mental Health, Treatment and Research, Brisbane, QLD, Australia
| | | | | | | | | |
Collapse
|
15
|
Martin T, Thomas SDM. Police officers' views of absconding from mental health units in Victoria, Australia. Int J Ment Health Nurs 2014; 23:145-52. [PMID: 23837639 DOI: 10.1111/inm.12036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
Collapse
Affiliation(s)
- Trish Martin
- School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia; Victorian Institute of Forensic Mental Health (Forensicare), Melbourne, Victoria, Australia
| | | |
Collapse
|
16
|
Psychiatric elopement: using evidence to examine causative factors and preventative measures. Arch Psychiatr Nurs 2013; 27:3-9. [PMID: 23352020 DOI: 10.1016/j.apnu.2012.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 07/16/2012] [Accepted: 07/31/2012] [Indexed: 11/23/2022]
Abstract
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.
Collapse
|
17
|
|
18
|
Windfuhr K, Kapur N. Suicide and mental illness: a clinical review of 15 years findings from the UK National Confidential Inquiry into Suicide. Br Med Bull 2011; 100:101-21. [PMID: 21948337 DOI: 10.1093/bmb/ldr042] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Suicide risk is most commonly associated with mental illness. In particular, suicide in people under mental health care presents distinct patterns of risk and opportunities for prevention due to their close proximity to specialist care. SOURCES OF DATA The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (Inquiry) is a unique UK-wide national database of all suicide cases in contact with mental health services in the 12 months preceding suicide. This review presents Inquiry findings from the beginning of the Inquiry in 1996 up to the present (2011) (15 years). AREAS OF AGREEMENT Suicide varies substantially by socio-demographic (age, gender) and clinical features (e.g. diagnosis; care variables). Effective suicide prevention initiatives should incorporate research findings to inform clinical practice and policy. AREAS OF CONTROVERSY Risk assessment remains one of the most difficult areas of clinical practice and management although all areas of clinical practice, research and policy development would benefit from continued high-quality studies. GROWING POINTS The Inquiry work has positively influenced mental health practice and policy in the UK. These changes include: falling suicide rates in mental health patients, informing suicide prevention strategies and developing safety checklists for mental health services. AREAS TIMELY FOR DEVELOPING RESEARCH Investigating suicide in non-mental health settings, investigating suicide following different treatment services and investigating models of service delivery could usefully inform future directions for improving patient safety.
Collapse
Affiliation(s)
- Kirsten Windfuhr
- Centre for Mental Health and Risk, 2nd Floor, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
| | | |
Collapse
|