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Patient outcomes following discharge from secure psychiatric hospitals: systematic review and meta-analysis
- Authors:
- FAZEL Seena, et al
- Journal article citation:
- British Journal of Psychiatry, 208(1), 2016, pp.17-25.
- Publisher:
- Cambridge University Press
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: The authors 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. (Edited publisher abstract)
Psychosocial approaches for individuals with schizophrenia in correctional and forensic psychiatric settings: a rapid review
- Authors:
- DUMONT Mathieu, et al
- Journal article citation:
- Journal of Forensic Practice, 20(3), 2018, pp.152-166.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to identify the psychosocial approaches that have been studied and for which positive outcomes have been reported for individuals with schizophrenia in correctional and forensic psychiatric settings. Design/methodology/approach: A rapid review of the literature was undertaken. A search was conducted on MEDLINE and PsycNET electronic databases. Each identified approach was analyzed to define their types and components. Findings: In total, 24 studies pertaining to 18 different psychosocial approaches were identified. Half of the studies used a quasi-experimental design with control group. Most frequent outcomes reported were improvements in knowledge about illness and problem solving. Seven studies reported positive outcomes related to issues more specific to this population (violence, aggression, and recidivism). Approaches associated with these studies used mainly traditional cognitive behavior therapy and cognitive remediation. The focus was on neurocognition, social cognition, social skills, emotion management and problem solving. Practical implications: This rapid review may enlighten clinical settings on psychosocial approaches for which positive outcomes have been reported with individuals with schizophrenia in correctional and forensic psychiatric settings. The picture obtained supports the idea of using integrated rehabilitation approaches that cover the aforementioned intervention focuses with this population. Originality/value: A significant contribution of the rapid review is based on the analysis of the psychosocial approaches identified. This process offers a closer look at the nature and content of the approaches used according to the outcomes reported. (Edited publisher abstract)