The Forensic Patient Journey: What Factors Increase Length of Stay?

The Forensic Patient Journey: What Factors Increase Length of Stay?

Lil Vrklevski¹, Andy Huang, Leon Yu

¹Sydney Local Health District, CONCORD, NSW, Australia
²Sydney Local Health District, CONCORD, NSW, Australia
³Sydney Local Health District, CONCORD, NSW, Australia

Abstract

Background: The connection between mental illness and violent behaviour is multi-faceted. There is empirical evidence that demonstrates a link between psychosis and increased violence risk. Much effort has gone into standardising assessment processes and developing tools to assist practitioners in assessing and managing violence risk, particularly with forensic patients. However there are fewer longitudinal studies that explore the forensic patient journey and the factors that significantly increase length of stay in custody, maximum, medium and low secure units. The aim of this study was to investigate the patient journey of forensic patients over a 10 year period, progressing through a low secure inpatient unit towards conditional release.
Methods: A quantitative method was used and data analysed with both descriptive and inferential statistics (ANOVAS and Pearson Correlations) to investigate the factors that affect the forensic journey of 23 patients.
Results: Apart from severity and management of mental illness, the factors that significantly increased length of stay were; history of substance use (F1,19 = 32204, p<0.02); previous forensic/criminal history (any type) (F1,21 = 417560, p< 0.01) most notably in low secure units; previous history of violence (F1,21 = 472, p<0.001) most notably in High secure units and type of Index Offence (murder) (F1,21 = 14213, p<0.02). Similarly, a strong positive correlation was found between severity of index offence and LOS (r=0.6, p=0.006). Discussion: In addition to clinical interventions that target management of mental illness in forensic patients, those targeting substance use and managing violence may have the most impact on reducing LOS.

Biography

Assoc. Prof. Lil Vrklevski B.A (Hons);LLB; MClinPsych; MBA; Dip.Grad.Research; PhD; MAPS; FCCLP; MACPA; GAICD is the Director of Psychology, Sydney Local Health District. Lil has over 30 years’ experience in law and clinical psychology. Lil is particularly interested in the relationship between the legal and mental health systems as well as the impact of trauma work on professionals. Lil is a reviewer on Traumatology, The Journal of Patient Safety, International Journal of Psychiatry in Clinical Practice, Australasian Psychiatry, Psychiatry, Psychology & Law and is Deputy Chair of the CRGH Human Research Ethics Committee and sits on the NSW Psychology Board.