Background

Increasing freedom of movement and community reintegration is a vital part of recovery for forensic service users. Clinical teams realize that risk of unauthorized leave exists when granting leave, tasking them with balancing the recovery-based treatment needs of the patients with the larger obligation to protect the public from undue risk of harm. While considerable literature exists on unauthorized leave from acute psychiatric units, there is still little research specific to unauthorized leave from forensic settings.

Aims

The aim of this study is twofold. First, to examine the prevalence rates and characteristics of unauthorized leaves (i.e., absconds and escapes) among 654 high security forensic patients. Second, to identify individual patient factors associated with unauthorized leaves. A broad array of risk factors is taken into account, including demographic, clinical, judicial and criminal factors.

Principal results

During the 8-year period (17th of November 2014 until 17th of November 2022), there were 59 unauthorized leaves, which represents a very low percentage (0.2%) relative to the total number of leaves. Most patients returned to the hospital or were caught within one week. The reasons that led to an unauthorized leave were in more than half of the incidents frustration and in more than a third goal-directed. Only a minority of the unauthorized leaves was associated with subsequent offending, notwithstanding substance use was more frequent. Patients that absconded or escaped more often had a personality and comorbid substance misuse disorder, but less often a paraphilic disorder. They were younger, had more convictions and higher risk scores. After logistic regression, only personality disorder, comorbid substance misuse disorder and number of convictions were independently associated with unauthorized leave.

Conclusions

The results of this study indicate that ULs occurred rarely, and in most instances, patients returned within a short period without further incidents. Personality disordered patients with comorbid substance misuse and prior convictions posed the greatest risk to abscond or escape. Overall, the rate of unauthorized leaves and subsequent offending was small relative to the total number of leaves. This suggests that the risk for absconding was assessed in an adequate manner by the clinical teams. The study hopefully adds to reducing the stigma towards leaves from forensic psychiatric hospitals.

中文翻译：

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医院休息。对两个高度安全的法医中心越狱和潜逃的八年审查

背景

增加行动自由和重新融入社区是法医服务用户康复的重要组成部分。临床团队意识到在准予休假时存在未经授权休假的风险，因此他们的任务是平衡患者基于康复的治疗需求与保护公众免受不当伤害风险的更大义务。虽然有大量关于急性精神病院未经授权离开的文献，但仍然很少有专门针对未经授权离开法医机构的研究。

宗旨

这项研究的目的是双重的。首先，检查 654 名高安全性法医患者中擅离职守（即潜逃和逃跑）的流行率和特征。其次，确定与未经授权休假相关的个体患者因素。广泛的风险因素被考虑在内，包括人口、临床、司法和犯罪因素。

主要成果

在这 8 年期间（2014 年 11 月 17 日至 2022 年 11 月 17 日），有 59 次擅自离职，占离职总数的比例非常低（0.2%）。大多数患者在一周内返回医院或被发现。导致未经授权离开的原因有一半以上是挫败感，三分之一以上是目标导向的。尽管滥用药物更为频繁，但只有少数未经授权的休假与随后的违规行为有关。潜逃或逃跑的患者更常患有人格障碍和共病的物质滥用障碍，但不太常见的是性倒错障碍。他们更年轻，有更多的信念和更高的风险评分。经过逻辑回归，只有人格障碍，

结论

这项研究的结果表明 UL 很少发生，并且在大多数情况下，患者在短时间内返回而没有发生进一步的事件。合并有药物滥用和先前定罪的人格障碍患者潜逃或逃跑的风险最大。总的来说，未经授权离开和随后的违规行为相对于离开总数来说是很小的。这表明临床团队以适当的方式评估了潜逃的风险。这项研究有望减少对法医精神病院离开的耻辱感。