BACKGROUND: Secure forensic hospital treatments are resource-intensive, aiming to rehabilitate offenders and enhance public safety. While these treatments consume significant portions of mental health budgets and show efficacy in some countries, their effectiveness in Czechia remains underexplored. Previous research has highlighted various factors influencing the likelihood of discharge from these institutions. Notably, the role of sociodemographic variables and the length of stay (LoS) in the context of forensic treatments has presented inconsistent findings across studies. METHODS: The study, part of the 'Deinstitutionalization project' in Czechia, collected data from all inpatient forensic care hospitals. A total of 793 patients (711 male, 79 female and 3 unknown) were included. Data collection spanned 6 months, with tools like HoNOS, HoNOS-Secure, MOAS, HCR-20V3 and AQoL-8D employed to assess various aspects of patient health, behaviour, risk and quality of life. RESULTS: The study revealed several determinants influencing patient discharge from forensic hospitals. Key assessment tools, such as HoNOS secure scores and the HCR-20 clinical subscale, showed that higher scores equated to lower chances of release. Furthermore, specific diagnoses like substance use disorder increased discharge odds, while a mental retardation diagnosis significantly reduced it. The type of index offense showed no influence on discharge decisions. CONCLUSION: Factors like reduced risk behaviours, absence of mental retardation diagnosis, social support and secure post-release housing plans played significant roles. The results underscored the importance of using standardized assessment tools over clinical judgement. A standout insight was the unique challenges faced by patients diagnosed with mental retardation, emphasizing a need for specialized care units or tailored programmes.

Department of Psychiatry 1st Faculty of Medicine Charles University and General University Hospital Prague Czechia

Psychiatric Hospital Bohnice Prague Czechia

See more in PubMed

Andreasson H., Nyman M., Krona H., Meyer L., Anckarsäter H., Nilsson T., Hofvander B. (2014). Predictors of length of stay in forensic psychiatry: The influence of perceived risk of violence. International Journal of Law and Psychiatry, 37(6), 635–642. 10.1016/j.ijlp.2014.02.038 PubMed DOI

Chester V., Völlm B., Tromans S., Kapugama C., Alexander R. T. (2018). Long-stay patients with and without intellectual disability in forensic psychiatric settings: Comparison of characteristics and needs. BJPsych Open, 4(4), 226–234. 10.1192/bjo.2018.24 PubMed DOI PMC

Crocker A. G., Nicholls T. L., Charette Y., Seto M. C. (2014). Dynamic and static factors associated with discharge dispositions: The national trajectory project of individuals found not criminally responsible on account of mental disorder (NCRMD) in Canada. Behavioral Sciences & the Law, 32(5), 577–595. 10.1002/bsl.2133 PubMed DOI

Davoren M., Abidin Z., Naughton L., Gibbons O., Nulty A., Wright B., Kennedy H. G. (2013). Prospective study of factors influencing conditional discharge from a forensic hospital: The DUNDRUM-3 program completion and DUNDRUM-4 recovery structured professional judgment instruments and risk. BMC Psychiatry, 13, 1–16. 10.1186/1471-244X-13-185 PubMed DOI PMC

Davoren M., Byrne O., O’Connell P., O’Neill H., O’Reilly K., Kennedy H. G. (2015). Factors affecting length of stay in forensic hospital setting: Need for therapeutic security and course of admission. BMC Psychiatry, 15(1), 1–15. 10.1186/s12888-015-0686-4 PubMed DOI PMC

Douglas K. S., Hart S. D., Webster C. D., Belfrage H. (2013). HCR-20 V3: Assessing risk for violence – User guide. Mental Health, Law, and Policy Institute, Simon Fraser University.

Eckert M., Schel S. H. H., Kennedy H. G., Bulten B. H. (2017). Patient characteristics related to length of stay in Dutch forensic psychiatric care. Journal of Forensic Psychiatry and Psychology, 28(6), 863–880. 10.1080/14789949.2017.1332771 DOI

Fazel S., Wolf A., Fimińska Z., Larsson H. (2016). Mortality, rehospitalization and violent crime in forensic psychiatric patients discharged from hospital: Rates and risk factors. PLoS ONE, 11(5), 1–14. 10.1371/journal.pone.0155906 PubMed DOI PMC

Gosek P., Kotowska J., Rowińska-Garbień E., Bartczak D., Heitzman J. (2020). Factors influencing length of stay of forensic patients: Impact of clinical and psychosocial variables in medium secure setting. Frontiers in Psychiatry, 11, 1–9. 10.3389/fpsyt.2020.00810 PubMed DOI PMC

Gosek P., Kotowska J., Rowińska-Garbień E., Bartczak D., Heitzman J. (2021). Treatment resistance and prolonged length of stay among schizophrenia inpatients in forensic institutions. Psychiatry Research, 298, 113771. 10.1016/j.psychres.2021.113771 PubMed DOI

Hare Duke L., Furtado V., Guo B., Völlm B. A. (2018). Long-stay in forensic-psychiatric care in the UK. Social Psychiatry and Psychiatric Epidemiology, 53(3), 313–321. 10.1007/s00127-017-1473-y PubMed DOI PMC

Hilton N. Z., Ham E., Kim S. (2022). The influence of changes in clinical factors on high-security forensic custody dispositions. Behavioral Sciences and the Law, 40(3), 467–479. 10.1002/bsl.2569 PubMed DOI

James M., Painter J., Buckingham B., Stewart M. W. (2018). A review and update of the Health of the Nation Outcome Scales (HoNOS). BJPsych Bulletin, 42(2), 63–68. 10.1192/bjb.2017.17 PubMed DOI PMC

Kastner R. M., Vitacco M. J., Anderson K., Batastini A. B. (2022). Risk assessment and provisional discharge: Predictive utility of the HCR-20. Psychology, Public Policy, and Law, 28(3), 332–343. 10.1037/law0000337 DOI

Kay S. R., Wolkenfeld F., Murrill L. M. (1988). Profiles of aggression among psychiatric patients. The Journal of Nervous and Mental Disease, 176(9), 539–546. 10.1097/00005053-198809000-00007 PubMed DOI

Maxwell A., Özmen M., Iezzi A., Richardson J. (2016). Deriving population norms for the AQoL-6D and AQoL-8D multi-attribute utility instruments from web-based data. Quality of Life Research, 25(12), 3209–3219. 10.1007/s11136-016-1337-z PubMed DOI

Páv M., Sebalo I., Vňuková M., Pabiánová Š., Málová V., Hollý M., Perkins D. (2022). Predicting discharge from long-term forensic treatment: Patients characteristics, protective factors, needs and treatment-related factors study in the Czechia. Journal of Forensic Psychiatry and Psychology, 33(1), 89–111. 10.1080/14789949.2022.2027995 DOI

Páv M., Skřivánková P., Wiseman C., Vňuková M., Blatníková Š., Hollý M. (2020). Forensic treatment services in the Czech republic: Current state and future challenges. International Journal of Forensic Mental Health, 19(3), 269–282.

Páv M., Vňuková M., Sebalo I. (2022). Factors affecting length of inpatient forensic stay: Retrospective study from Czechia. Frontiers in Psychiatry, 13, 825615. 10.3389/fpsyt.2022.825615 PubMed DOI PMC

Richardson J., Iezzi A., Khan M. A., Maxwell A. (2014). Validity and reliability of the assessment of quality of life (AQoL)-8D multi-attribute utility instrument. The Patient - Patient-Centered Outcomes Research, 7(1), 85–96. 10.1007/s40271-013-0036-x PubMed DOI PMC

Ross T., Querengässer J., Fontao M. I., Hoffmann K. (2012). Predicting discharge in forensic psychiatry: The legal and psychosocial factors associated with long and short stays in forensic psychiatric hospitals. International Journal of Law and Psychiatry, 35(3), 213–221. 10.1016/j.ijlp.2012.02.011 PubMed DOI

Shah A., Waldron G., Boast N., Coid J. W., Ullrich S. (2011). Factors associated with length of admission at a medium secure forensic psychiatric unit. Journal of Forensic Psychiatry and Psychology, 22(4), 496–512. 10.1080/14789949.2011.594902 DOI

Völlm B. A., Edworthy R., Huband N., Talbot E., Majid S., Holley J., Furtado V., Weaver T., McDonald R., Duggan C. (2018). Characteristics and pathways of long-stay patients in high and medium secure settings in England; A secondary publication from a large mixed-methods study. Frontiers in Psychiatry, 9, 140. 10.3389/fpsyt.2018.00140 PubMed DOI PMC

Wing J. K., Beevor A. S., Curtis R. H., Park S. B., Hadden S., Burns A. (1998). Health of the Nation Outcome Scales (HoNOS). Research and development. The British journal of psychiatry : The journal of mental science, 172, 11–18. 10.1192/bjp.172.1.11 PubMed DOI

Yudofsky S., Silver J., Jackson W., Endicott J., Williams D. (1986). The Overt Aggression Scale for the objective rating of verbal and physical aggression. American Journal of Psychiatry, 143(1), 35–39. 10.1176/ajp.143.1.35 PubMed DOI

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