Longer than prison? A comparison of length of stay in a medium security hospital and prison for perpetrators of violent crimes other than homicide or attempted homicide.

BACKGROUND: Concerns have been raised that people detained in secure hospitals after a criminal act spend longer in a locked institution than people sent to prison for similar offending, but research evidence is scarce and conflicting. AIMS: To compare the length of secure hospitalisation of people convicted of crimes for which flexible sentencing is allowed with length of time in prison for people serving a prison sentence for similar crimes who were not found mentally ill. METHODS: A records-based, retrospective study was conducted comparing length of stay of all inpatients in one medium security hospital in Poland, hospitalised between 2014 and 2018, who had been convicted of any interpersonal crime other than homicide or attempted homicide, and data on all sentenced prisoners in Poland on 09.05.2018 convicted of a similar range of offences. Homicide was excluded because, in Poland, it usually attracts a fixed sentence-a life sentence until the 1970s and currently a 25-year imprisonment-so disrupting comparisons. RESULTS: Eighty-two patients completed their secure hospital stay within the study period or were still hospitalised at the census point 09.05.2018, only 10 of them women. Male patients convicted of stalking or similar threatening offence or 'mistreatment' spent, on average, almost twice as long confined to hospital than men sentenced to imprisonment spent in prison (28.8 months, respectively). By contrast, men hospitalised after sex offences were confined for over three years less than those sentenced to prison. Only bodily harm offences attracted comparable lengths of stay in hospital and prison. CONCLUSIONS: Our findings confirm significant disparities in length of time spent in a closed institution after offences of serious interpersonal violence, according to whether that institution was prison or hospital, but not all in the same direction. Next steps should explore reasons for this and relative longer-term outcomes.

Long-term forensic psychiatric inpatient treatment - review of the selected literature and the analysis of data from the medium secured forensic psychiatry unit. / Wieloletnie detencje psychiatryczne ­ przeglad wybranego pismiennictwa i analiza danych z oddzialu psychiatrii sadowej o wzmocnionym stopniu zabezpieczenia.

OBJECTIVES: The aim of this study was to perform an analysis of the risk factors of long-term psychiatric detention, defined as a stay in forensic institution exceeding respectively 60 and 84 months, based on data obtained from 150 patients from medium secure forensic psychiatry unit. The discussion was preceded by an analysis of the available literature in this field. The sociodemographic factors, the course of the mental disorder, the characteristic of committed criminal acts, aggressive or self-destructive behavior and the clinical characteristic of the illness in the last 6 months of psychiatric detention were analyzed. METHODS: A pilot study was based on a retrospective analysis of data from medical records and psychiatric experts' opinions of a cross-sectional nature. Due to the variables' characteristic, the Student's t-tests, Spearman's correlation and the Kruskal-Wallis rank ANOVA were used. RESULTS: Risk of long-term hospitalization significantly correlated with factors related to the course of the last 6 months of inpatient treatment, including the mental state of patients, the occurrence of aggressive behaviors and the response to pharmacological treatment. There was no significant effect of demographic factors or coexisting addiction to alcohol and psychoactive substances. The risk of long-term psychiatric detention increased with the duration of the illness. There were no correlations with the age of the patients at the time of admission nor number of detentions. The nature of the diagnosis was also not found to be a risk factor. CONCLUSIONS: Our study is the first systematic attempt to assess the risk factors of long-term psychiatric detention in a group of patients of forensic psychiatry centers in Poland. We hope that the presented results will rise a discussion on the shape of psychiatric care in Poland and encourage further research in this area, as well as they will contribute to the optimization of the treatment process.

Treatment resistance and prolonged length of stay among schizophrenia inpatients in forensic institutions.

Patients suffering from schizophrenia spectrum disorders are the largest group of forensic inpatients worldwide, therefore the identification of factors that influence how long service users experiencing schizophrenia spend in forensic hospitals is one of the most important research areas in forensic psychiatry. Methods: Analysis of data of 87 schizophrenia inpatients, hospitalized in a medium secure forensic unit. Results: Mental disorders among family members, alcohol or substance dependence diagnosis, the severity of the criminal behavior demonstrated by homicide/homicide attempts and features of treatment resistance as persistent psychotic symptoms and current treatment with >1 antipsychotics was proven to influence the length of stay (LoS).

Factors Influencing Length of Stay of Forensic Patients: Impact of Clinical and Psychosocial Variables in Medium Secure Setting.

OBJECTIVES: Forensic 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. METHODS: We 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. RESULTS: The 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. CONCLUSIONS: Our 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.