Simpson Alexander I F, Penney Stephanie R, Fernane Stephanie, Wilkie Treena
Complex Mental Illness Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, M6J 1H4, ON, Canada.
University of Toronto, Toronto, Canada.
BMC Psychiatry. 2015 May 3;15:103. doi: 10.1186/s12888-015-0474-1.
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.
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.
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.
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.
很少有研究调查从法医医院潜逃的情况，也没有关于旨在减少法医环境中此类事件的干预措施的已发表研究。我们开展了一项研究，以探讨一项新政策的影响，该政策采用结构化专业判断和跨学科团队方法来授予法医患者特权。我们评估了该政策对一家大都市法医机构潜逃率和类型的影响。
鉴于对我院潜逃率的担忧，实施了一项新政策来指导授予医院场地和社区访问特权的流程。采用A-B设计，我们调查了该政策实施前18个月和实施后18个月潜逃事件的发生率、特征和动机，以评估其有效性。
在42个月的研究期间，86名患者发生了188起潜逃事件。潜逃率从新政策实施前所有有风险患者的17.8%逐渐下降到实施期间的13.8%，并在实施后进一步降至12.0%。该政策对潜逃事件有不同的影响，即无人陪同外出时发生的潜逃事件减少最多；这在一定程度上被医院病房内或工作人员陪同外出时潜逃事件的增加所抵消。七起潜逃事件包括轻微暴力事件，两起包括实施其他非法行为。在所研究的时间段内，最常见的潜逃动机是无聊或沮丧感。政策实施前的出院率为22.9%，实施后为22.7%，表明患者最终重新融入社区的比率没有变化。
关于医院场地和社区访问特权的结构化和基于团队的决策方法似乎降低了总体潜逃率，而没有减缓法医患者重新融入社区的速度。
