A prospective study of pathways to hospital readmission in Canadian forensic psychiatric patients

Abstract

Individuals admitted to secure care often experience lengthy hospitalizations and are likely to be admitted on more than one occasion. In the context of growing demand and costs associated with secure care, the current study investigates the frequency and reasons for readmission among 87 forensic patients recently discharged into the community. We identify risk factors that are associated with the likelihood of readmission and describe areas of overlap and discordance with the existing literature in civil and forensic samples. Using a prospective design that included patient follow-up interviews and records review, we found that 28% of patients were readmitted on one or more occasions over a 12-month period. Psychiatric decompensation, substance use, and treatment non-adherence were the central reasons prompting readmission. Patients with one or more readmissions were found to have spent significantly more time in the forensic mental health system as compared to patients not readmitted. They were more likely to have a substance use disorder and were estimated to be at higher risk for violence. Results replicate the finding of low rates of serious violence and reoffending among discharged forensic patients, and substantiate the centrality of substance use as a growing and clinically important treatment issue.

Keywords:

• Hospital readmission
• forensic mental health
• substance use
• violence risk

Notes

1. For those patients who were readmitted but were also in hospital at the study’s end, we documented the date of discharge from the health record in order to produce accurate figures on readmission duration.

2. The sample size of female participants precluded further analyses by sex, but we note that bivariate correlations within the female sample revealed significantly positive associations between the likelihood of readmission and (1) duration under the review board (r = .66, p < .05), as in males, and (2) the presence of substance use problems (χ² = 3.76, p = .05), also as found in males. Further, a trend was revealed between readmission and the HCR-20^V3 summary risk rating in females (r = .58, p = .08).