Understanding and reducing unauthorized leaves of absence from forensic mental health settings: a literature review

Abstract

ABSTRACT Receiving passes and privileges to leave secure hospital settings has important therapeutic value for forensic patients. However, events involving patient unauthorized leave of absence (ULOA) prompt public safety concerns. To better understand how to address ULOA, we reviewed literature on patient leave and ULOA from forensic mental health settings, and technological monitoring of forensic patients. We systematically searched the following databases: MEDLINE, PsycINFO, and CINAHL. Searches were not restricted by language, study type, or time period. While the literature lacks a consistent convention to calculate ULOA rates, it suggests that forensic ULOA events are generally infrequent and benign. Common motivations for absconding include boredom and frustration. Structured professional guidelines may enhance transparency and confidence in decision-making about patient leave, but there is a need for validation of tools specific to ULOA risk. More research on interventions designed to reduce forensic ULOA, including use of electronic monitoring, is also needed. The therapeutic risk of forensic patient absconding will never be fully eliminated. Literature to date suggests promising avenues for future research and efforts to address ULOA, such as increasing opportunities for therapeutic and recreational activities, and evaluation of existing and development of new interventions.