Abstract
ObjectivesForensic psychiatric care has two, often contradictory, aims—the treatment of mentally ill offenders and the isolation of the perpetrators to ensure public safety. It is essential to ensure that any periods of liberty deprivation do not last longer than necessary to provide appropriate treatment. Therefore, identifying the factors affecting the length of stay (LoS) is one of the most important research areas in the forensic psychiatry. The literature on this subject is scarce and to date there no data available on LoS for patients in Eastern or Central European patients.MethodsWe conducted a retrospective analysis of data for 150 inpatients in a medium secure unit. Based on a literature review and clinical experience, variables potentially influencing LoS were identified and included in the analysis.ResultsThe variables that were significantly associated with LoS included duration of mental illness; severity of index offense; whether a crime was committed as a result of hallucinations or during drug treatment discontinuation; if the index offenses was a continuous crime (crimes committed over an extended period of time); persistent psychosis; multiple antipsychotic treatments; as well as a diagnosis of schizophrenia and schizoaffective disorder.ConclusionsOur findings are highly consistent with observations made by other researchers. However, contrary the majority of previous studies our project incorporates data concerning the clinical presentation of patients. For example, we demonstrate that variables measuring treatment resistance might be one of the crucial determinants of LoS, which is a novel research finding.
Highlights
Forensic psychiatric care has to meet two, often contradictory, expectations—treatment of mentally ill offenders and their reintegration with the society, as well as isolation of perpetrators and ensuring public safety
Most European countries allow for forensic inpatient treatment, sometimes called “psychiatric detention”, which often exceeds the maximum length of a prison sentence that would be adjudicated for similar offenses committed by healthy perpetrators [1]
Forensic inpatients’ length of stay (LoS) and factors affecting LoS are of special interest among forensic professionals
Summary
Forensic psychiatric care has to meet two, often contradictory, expectations—treatment of mentally ill offenders and their reintegration with the society, as well as isolation of perpetrators and ensuring public safety. Most European countries allow for forensic inpatient treatment, sometimes called “psychiatric detention”, which often exceeds the maximum length of a prison sentence that would be adjudicated for similar offenses committed by healthy perpetrators [1]. This poses a risk of disproportionately long and protracted stays in forensic institutions. Unstable patients may be prematurely discharged, which may lead to worse overall outcomes, poorer quality of life, and increased violence and re-admission risk. The identification of specific features of therapy and treatment duration that may result in optimized care, better risk assessment, and more appropriate management may lead to improved quality of care and patients’ quality of life
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