Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia.
Psychiatric Hospital Bohnice, Prague, Czechia.
Int J Soc Psychiatry. 2024 Sep;70(6):1075-1082. doi: 10.1177/00207640241255575. Epub 2024 Jun 6.
Secure forensic hospital treatments are resource-intensive, aiming to rehabilitate offenders and enhance public safety. While these treatments consume significant portions of mental health budgets and show efficacy in some countries, their effectiveness in Czechia remains underexplored. Previous research has highlighted various factors influencing the likelihood of discharge from these institutions. Notably, the role of sociodemographic variables and the length of stay (LoS) in the context of forensic treatments has presented inconsistent findings across studies.
The study, part of the 'Deinstitutionalization project' in Czechia, collected data from all inpatient forensic care hospitals. A total of 793 patients (711 male, 79 female and 3 unknown) were included. Data collection spanned 6 months, with tools like HoNOS, HoNOS-Secure, MOAS, HCR-20V3 and AQoL-8D employed to assess various aspects of patient health, behaviour, risk and quality of life.
The study revealed several determinants influencing patient discharge from forensic hospitals. Key assessment tools, such as HoNOS secure scores and the HCR-20 clinical subscale, showed that higher scores equated to lower chances of release. Furthermore, specific diagnoses like substance use disorder increased discharge odds, while a mental retardation diagnosis significantly reduced it. The type of index offense showed no influence on discharge decisions.
Factors like reduced risk behaviours, absence of mental retardation diagnosis, social support and secure post-release housing plans played significant roles. The results underscored the importance of using standardized assessment tools over clinical judgement. A standout insight was the unique challenges faced by patients diagnosed with mental retardation, emphasizing a need for specialized care units or tailored programmes.
安全的法医医院治疗需要耗费大量资源，旨在治疗罪犯并增强公共安全。虽然这些治疗方法消耗了心理健康预算的很大一部分，并且在一些国家显示出了疗效，但在捷克，它们的效果仍未得到充分探索。先前的研究强调了影响从这些机构出院可能性的各种因素。值得注意的是，在法医治疗中，社会人口统计学变量和住院时间（LoS）的作用在不同研究中得出了不一致的结果。
该研究是捷克“去机构化项目”的一部分，从所有住院法医护理医院收集数据。共纳入 793 名患者（711 名男性，79 名女性和 3 名未知性别）。数据收集持续了 6 个月，使用 HoNOS、HoNOS-Secure、MOAS、HCR-20V3 和 AQoL-8D 等工具评估患者健康、行为、风险和生活质量的各个方面。
该研究揭示了影响患者从法医医院出院的几个决定因素。关键评估工具，如 HoNOS 安全评分和 HCR-20 临床子量表，表明分数越高，出院的可能性越低。此外，特定的诊断，如物质使用障碍，增加了出院的几率，而智力迟钝的诊断则显著降低了出院的几率。索引犯罪的类型对出院决定没有影响。
减少风险行为、没有智力迟钝的诊断、社会支持和安全的出院后住房计划等因素起着重要作用。研究结果强调了使用标准化评估工具而不是临床判断的重要性。一个突出的见解是，被诊断为智力迟钝的患者面临着独特的挑战，这强调了需要专门的护理单位或量身定制的方案。
