Abstract
BackgroundIncidents 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.MethodsThe 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).ResultsDuring 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).ConclusionPotentially-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.
Highlights
Incidents of absconsion, defined as being absent from hospital without permission, are rare in forensic psychiatric settings [1]
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 current study was conducted within the South London and Maudsley (SLaM) National Health Service (NHS) Foundation Trust which provides secondary mental health care to individuals residing in four southeast London boroughs (Lambeth, Southwark, Lewisham, and Croydon)
Summary
Incidents of absconsion, defined as being absent from hospital without permission, are rare in forensic psychiatric settings [1] These rare incidents can have potentially tragic outcomes including the occurrence of further incidents of serious violence; and during the past decade there have been several high profile cases of this nature in the UK. Such cases can lead to public inquires [2,3] and attract considerable media attention, both of which are likely to undermine the public’s confidence in the ability of these services to safely treat offenders with mental health problems. We aimed to identify predictors of absconsion over a two-year period and investigate the feasibility of developing a brief risk assessment scale
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