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Meta-Analysis
. 2016 Jan;208(1):17-25.
doi: 10.1192/bjp.bp.114.149997.

Patient outcomes following discharge from secure psychiatric hospitals: systematic review and meta-analysis

Seena Fazel  1 , Zuzanna Fimińska  2 , Christopher Cocks  2 , Jeremy Coid  2
Affiliations
Meta-Analysis

Patient outcomes following discharge from secure psychiatric hospitals: systematic review and meta-analysis

Seena Fazel et al. Br J Psychiatry. 2016 Jan.

Abstract

Background: Secure hospitals are a high-cost, low-volume service consuming around a fifth of the overall mental health budget in England and Wales.

Aims: 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.

Method: 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.

Results: 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.

Conclusions: 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.

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Conflict of interest statement

Declaration of interest

None.

Figures

Fig. 1
Fig. 1
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.
Fig. 2
Fig. 2
Psychiatric hospital readmission rates for discharged forensic psychiatric patients per 100 000 person-years. Weights are from random-effects analysis.
Fig. 3
Fig. 3
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.
Fig. 4
Fig. 4
Repeat violent offending rates for discharged forensic patients per 100 000 person-years. Weights are from random-effects analysis.
Fig. 5
Fig. 5
Prevalence ratios comparing reoffending rates of released prisoners with forensic psychiatric patients. Weights are from random-effects analysis. Prevalence ratios above 1 mean that rates of reoffending are higher in prisoners than in forensic psychiatric patients matched by age-band where possible.
See this image and copyright information in PMC

References

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