Secure hospitals are a high-cost, low-volume service consuming around a fifth of the overall mental health budget in England and Wales.
A systematic review and meta-analysis of adverse outcomes after discharge along with a comparison with rates in other clinical and forensic groups in order to inform public health and policy.
We searched for primary studies that followed patients discharged from a secure hospital, and reported mortality, readmissions or reconvictions. We determined crude rates for all adverse outcomes.
In total, 35 studies from 10 countries were included, involving 12 056 patients out of which 53% were violent offenders. The crude death rate for all-cause mortality was 1538 per 100 000 person-years (95% CI 1175–1901). For suicide, the crude death rate was 325 per 100 000 person-years (95% CI 235–415). The readmission rate was 7208 per 100 000 person-years (95% CI 5916–8500). Crude reoffending rates were 4484 per 100 000 person-years (95% CI 3679–5287), with lower rates in more recent studies.
There is some evidence that patients discharged from forensic psychiatric services have lower offending outcomes than many comparative groups. Services could consider improving interventions aimed at reducing premature mortality, particularly suicide, in discharged patients.
Below: Crude mortality rates of discharged forensic psychiatry patients for all-cause mortality in England and Wales compared with other countries. Rates are per 100 000 person-years. Weights are from random-effects analysis.
Below: Psychiatric hospital readmission rates for discharged forensic psychiatric patients per 100 000 person-years
Below: Repeat offending rates for discharged forensic patients per 100 000 person-years. Weights are from random-effects analysis. The two outliers (combined no. reoffenders = 6) are not shown.
Below:Repeat violent offending rates for discharged forensic patients per 100 000 person-years
Below: Prevalence ratios comparing reoffending rates of released prisoners with forensic psychiatric patients
Seena Fazel, MD, Zuzanna Fimińska, MSc, University of Oxford, Oxford, UK; Christopher Cocks, MD, Department of Psychiatry, University of New South Wales, Sydney, Australia; Jeremy Coid, MD, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, UK
Correspondence: Seena Fazel, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX. UK. Email:firstname.lastname@example.org
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