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Open Access Highly Accessed Research article

Characteristics and motivations of absconders from forensic mental health services: a case-control study

Treena Wilkie12, Stephanie R Penney12*, Stephanie Fernane1 and Alexander I F Simpson12

Author Affiliations

1 Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada M6J 1H4

2 University of Toronto, Toronto, ON, Canada

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BMC Psychiatry 2014, 14:91  doi:10.1186/1471-244X-14-91

Published: 27 March 2014

Abstract

Background

Absconding from hospital is a significant health and security issue within psychiatric facilities that can have considerable adverse effects on patients, their family members and care providers, as well as the wider community. Several studies have documented correlates associated with absconding events among general psychiatric samples; however, few studies have examined this phenomenon within samples of forensic patients where the perception of threat to public safety in the event of an unauthorized absence from hospital is often higher.

Methods

We investigate the frequency, timing, and determinants of absconding events among a sample of forensic psychiatric patients over a 24-month period, and compare patients who abscond to a control group matched along several sociodemographic and clinical dimensions. We explore, in a qualitative manner, patients’ motives for absconding.

Results

Fifty-seven patients were responsible for 102 incidents of absconding during the two year study window. Forensic patients who absconded from hospital were more likely to have a history of absconding attempts, a diagnosed substance use disorder, as well as score higher on a structured professional violence risk assessment measure. Only one of the absconding events identified included an incident of minor violence, and very few included the commission of other illegal behaviors (with the exception of substance use). The most common reported motive for absconding was a sense of boredom or frustration.

Conclusions

Using an inclusive definition of absconding, we found that absconding events were generally of brief duration, and that no member of the public was harmed by patients who absconded. Findings surrounding the motivations of absconders suggest that improvements in therapeutic communication between patients and clinical teams could help to reduce the occurrence of absconding events.

Keywords:
Absconding; Risk; Forensic mental health