Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Justice Health & Forensic Mental Health Network, Sydney, NSW, Australia.
Eur Psychiatry. 2018 Mar;49:1-8. doi: 10.1016/j.eurpsy.2017.11.005. Epub 2018 Jan 30.
The recall of conditionally discharged forensic patients in England is a formal order from the Ministry of Justice under the Mental Health Act (1983) which has the power to revoke conditional release and direct readmission to hospital. Recall has significant implications for the individual and for hospital services, but despite this, little is known about predictors of recall for forensic patients.
We examined the rate of recall for 101 patients conditionally discharged from medium secure forensic inpatient services between 2007 and 2013. Demographic, clinical, and forensic factors were examined as possible predictors of time to recall using Cox regression survival techniques.
Conditionally discharged patients were followed for an average of 811 days, during which 45 (44.5%) were recalled to hospital. Younger age (HR 1.89; 95% CI 1.02-3.49; p = 0.04), non-white ethnicity (HR 3.44; 95% CI 1.45-8.13), substance abuse history (HR 2.52; 95% CI 1.17-5.43), early violence (HR 1.90; 95% CI 1.03-3.50), early childhood maladjustment (HR 1.92; 95% CI 1.01-3.68), treatment with a depot medication (HR 2.17; 95% CI 1.14-4.11), being known to mental health services (HR 3.44; 95% CI 1.06-11.16), and a psychiatric admission prior to the index admission (HR 2.44; 95% CI 1.08-5.52) were significantly associated with a shorter time to recall. Treatment with clozapine reduced the risk of recall to hospital (HR 0.40; 95% CI 0.20-0.79).
Time to recall can be predicted by a range of factors that are readily available to clinical teams. Further research is required to determine if targeted interventions can modify the likelihood or time to recall for conditionally released forensic patients.
在英格兰，有条件释放的法医患者的召回是司法部根据《精神卫生法》（1983 年）发出的正式命令，该命令有权撤销有条件释放并直接将患者送回医院。召回对个人和医院服务都有重大影响，但尽管如此，对于法医患者的召回预测因素知之甚少。
我们检查了 2007 年至 2013 年间从中等安全法医住院服务中有条件出院的 101 名患者的召回率。使用 Cox 回归生存技术，检查人口统计学、临床和法医因素是否可能成为召回时间的预测因素。
有条件出院的患者平均随访 811 天，在此期间有 45 名（44.5%）被召回住院。年龄较小（HR 1.89；95%CI 1.02-3.49；p=0.04）、非白人种族（HR 3.44；95%CI 1.45-8.13）、药物滥用史（HR 2.52；95%CI 1.17-5.43）、早期暴力（HR 1.90；95%CI 1.03-3.50）、儿童期早期失调（HR 1.92；95%CI 1.01-3.68）、使用长效药物治疗（HR 2.17；95%CI 1.14-4.11）、已知精神卫生服务（HR 3.44；95%CI 1.06-11.16）和索引入院前的精神科入院（HR 2.44；95%CI 1.08-5.52）与召回时间较短显著相关。使用氯氮平治疗可降低被召回住院的风险（HR 0.40；95%CI 0.20-0.79）。
召回时间可以通过一系列临床团队易于获得的因素来预测。需要进一步研究以确定针对有条件释放的法医患者的有针对性干预措施是否可以改变召回的可能性或时间。
