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. 2025 Jun 14;19(1):19.
doi: 10.1186/s13033-025-00675-9.

Analysing length of stay disparities in inpatient forensic psychiatric care: a cross-sectional study in Czechia

Marek Páv  1   2 , Ondřej Vaníček  3 , Jiří Závora  4 , Jaroslav Pekara  5   6 , Michaela Zahrádka-Kȍhlerová  5   7 , Simona Papežová  5 , Martin Anders  8
Affiliations

Analysing length of stay disparities in inpatient forensic psychiatric care: a cross-sectional study in Czechia

Marek Páv et al. Int J Ment Health Syst. .

Abstract

Background: Length of stay (LoS) is a critical parameter of inpatient forensic treatment functioning. Inpatient forensic LoS in Czechia varies across hospitals with the number of patients per 100,000 inhabitants and the treatment duration. We aimed to analyse these inter-hospital differences and provide relevant sociodemographic and treatment-related data.

Methods: We collected descriptive parameters from 841 forensic inpatients from 13 hospitals in Czechia, with follow-up data collection after 6 months (N = 800). Data from eight hospitals with > 50 patients (N = 765) were entered into linear regression analyses with subsequent resampling to identify differences in LoS associated with index offence, diagnosis, and treatment type, thereby highlighting interhospital variations.

Results: The cohort comprised predominantly males (mean age, 41.84 years; standard deviation [SD] 3.63) with extended mental health histories; the mean main diagnosis length was 13.2 years (SD 12.18). Most inmates committed violent offences, with psychotic, substance use, or paraphilic disorders predominating. Family contact remained common despite the patients' poor socioeconomic status. The mean LoS was 1,327.58 (SD 1642.41) days. We observed significant differences in LoS among patients from the same diagnostic group. Within the whole system, patients with substance abuse disorders, psychotic disorders, and intellectual disabilities stayed for 760, 1490, and 2441 days, respectively. Violent index offences increased LoS in most hospitals, as did sexual offences, but "other" minor criminal offences (non-violent, non-sexual) were associated with increased LoS only in some hospitals. Sex offender treatment significantly affected LoS in some hospitals, while enrolment into substance use programmes shortened it.

Conclusions: Our study revealed significant inter-hospital variations in LoS associated with index offences, diagnoses, or treatment programs, which could be related to previously unrecognised institutional factors. Regular evaluation of treatment outcomes and implementation of standardised guidelines across the entire system is necessary to balance these differences. The insights provided into inpatient treatment in Czechia can be used to guide policy and practice improvements, enhancing the quality of forensic psychiatric care and ensuring the rights and well-being of the patients. The study addressed the knowledge gap existing in the available literature regarding previously unrecognised factors influencing the LoS at the system "mezzo" level.

Keywords: Czechia; Forensic length of stay; Forensic psychiatric care; Forensic psychiatry; Hospital effect; Inpatient forensic treatment; Linear regression analysis; Mental disorder; Multicentre study; Representative sample.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committee of Bohnice Psychiatric Hospital and conducted in accordance with national legislation and institutional requirements. All participants provided informed consent prior to inclusion in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Number of patients per hospital and number of patients per 100,000 residents in a catchment area, all forensic hospitals in Czechia (N = 841). CAI, catchment area inhabitants
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