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.

3rd Faculty of Medicine Charles University Ruská 87 Prague 10 100 00 Czech Republic

Bohnice Psychiatric Hospital Department of Psychiatry Ústavní 91 Prague 8 181 02 Czech Republic

Department of Psychiatry 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Ke Karlovu 11 Prague Prague 2 128 08 Czech Republic

Institute of Forensic Sciences Prague Čáslavská 8 Prague 2 130 00 Czech Republic

Medical College Duškova 7 Prague 5 150 00 Czech Republic

National Institute of Mental Health Topolová 748 Klecany 250 67 Czech Republic

Zobrazit více v PubMed

Beis P, Graf M, Hachtel H. Impact of Legal Traditions on Forensic Mental Health Treatment Worldwide. Front Psychiatry [Internet]. 2022 Apr 25 [cited 2023 Jul 3];13:876619. Available from: http://www.ncbi.nlm.nih.gov/pubmed/35546946 PubMed PMC

Edworthy R, Vollm B. Long-stay in high and medium secure forensic psychiatric care – Prevalence, patient characteristics and pathways in England. European Psychiatry [Internet]. 2016 [cited 2020 Oct 13];33(S1):S180–S180. Available from: https://www.cambridge.org/core/journals/european-psychiatry/article/longstay-in-high-and-medium-secure-forensic-psychiatric-care-prevalence-patient-characteristics-and-pathways-in-england/451433CF7E56CDEAE6695926A505FF5E

Dressing H, Salize HJ. Compulsory admission of mentally ill patients in European Union Member States. Soc Psychiatry Psychiatr Epidemiol [Internet]. 2004 Oct 1 [cited 2023 Jun 30];39(10):797–803. Available from: https://link.springer.com/article/10.1007/s00127-004-0814-9 PubMed

van Lier E, Tort-Herrando V. Organization and funding of forensic psychiatric facilities across Europe. Forensic psychiatry and psychology in Europe. Cham: Springer International Publishing; 2018. pp. 113–28.

Tomlin J, Lega I, Braun P, Kennedy HG, Herrando VT, Barroso R et al. Forensic mental health in Europe: some key figures. Soc Psychiatry Psychiatr Epidemiol [Internet]. 2021 Jan 1 [cited 2022 Jul 25];56(1):109–17. Available from: https://link.springer.com/article/10.1007/s00127-020-01909-6 PubMed PMC

Salize HJ, Dreßing H. Placement and treatment of mentally ill offenderes- legislation and practice in EU members. Manheim; 2005.

Salize HJ, Lepping P, Dressing H. How harmonized are we? Forensic mental health legislation and service provision in the European Union. Crim Behav Ment Health [Internet]. 2005 [cited 2023 Jul 3];15(3):143–7. Available from: https://pubmed.ncbi.nlm.nih.gov/16575818/ PubMed

Salize HJ, Dressing H, Fangerau H, Gosek P, Heitzman J, Markiewicz I, et al. Highly varying concepts and capacities of forensic mental health services across the European union. Front Public Health. 2023;11:75. PubMed PMC

Di Lorito C, Castelletti L, Lega I, Gualco B, Scarpa F, Vӧllm B. The closing of forensic psychiatric hospitals in Italy: Determinants, current status and future perspectives. A scoping review. Int J Law Psychiatry [Internet]. 2017 Nov 1 [cited 2023 Jul 3];55:54–63. Available from: https://pubmed.ncbi.nlm.nih.gov/29157512/ PubMed

Mundt AP, Frančišković T, Gurovich I, Heinz A, Ignatyev Y, Ismayilov F, et al. Changes in the provision of institutionalized mental health care in post-communist countries. PLoS One [Internet]. 2012 Jun 8 [cited 2021 May 4];7(6). Available from: /pmc/articles/PMC3371010/ PubMed PMC

Chow WS, Priebe S. How has the extent of institutional mental healthcare changed in Western Europe? Analysis of data since 1990 [Internet]. Vol. 6, BMJ Open. BMJ Publishing Group; 2016 [cited 2021 May 4]. p. 10188. Available from: /pmc/articles/PMC4854016/ PubMed PMC

Priebe S, Frottier P, Gaddini A, Kilian R, Lauber C, Martínez-Leal R et al. Mental health care institutions in nine European countries, 2002 to 2006. Psychiatr Serv [Internet]. 2008 [cited 2023 Jul 3];59(5):570–3. Available from: https://pubmed.ncbi.nlm.nih.gov/18451020/ PubMed

Völlm BA, Clarke M, Herrando VT, Seppänen AO, Gosek P, Heitzman J et al. European Psychiatric Association (EPA) guidance on forensic psychiatry: Evidence based assessment and treatment of mentally disordered offenders. Eur Psychiatry [Internet]. 2018 Jun 1 [cited 2023 Jul 7];51:58–73. Available from: https://pubmed.ncbi.nlm.nih.gov/29571072/ PubMed

van der Wolf M, van Marle H. Legal approaches to criminal responsibility of mentally disordered offenders in Europe. Forensic Psychiatry Psychol Europe. 2018;31–44.

Edworthy R, Sampson S, Völlm B. Inpatient forensic-psychiatric care: Legal frameworks and service provision in three European countries. Int J Law Psychiatry [Internet]. 2016 Jul [cited 2018 Sep 13];47:18–27. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0160252716300401 PubMed

Sampson S, Edworthy R, Völlm B, Bulten E. Long-Term forensic mental health services: an exploratory comparison of 18 European countries. Int J Forensic Ment Health. 2016;15(4):333–51.

Eckert Mareike, Schel SHH, Harry G, Kennedy K, Bulten BH (Erik), editors. Patient characteristics related to length of stay in Dutch forensic psychiatric care. J Forens Psychiatry Psychol. 2017;28(6):863–880.

Davoren M, Byrne O, O’Connell P, O’Neill H, O’Reilly K, Kennedy HG. Factors affecting length of stay in forensic hospital setting: Need for therapeutic security and course of admission. BMC Psychiatry [Internet]. 2015 Nov 23 [cited 2020 Oct 12];15(1):1–15. Available from: https://link.springer.com/articles/10.1186/s12888-015-0686-4 PubMed PMC

Völlm BA, Edworthy R, Huband N, Talbot E, Majid S, Holley J et al. Characteristics and pathways of long-stay patients in high and medium secure settings in England; A secondary publication from a large mixed-methods study. Front Psychiatry [Internet]. 2018 Apr 16 [cited 2020 Jul 9];9(APR):140. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29713294 PubMed PMC

Gosek P, Kotowska J, Rowińska-Garbień E, Bartczak D, Heitzman J. Factors influencing length of stay of forensic patients: impact of clinical and psychosocial variables in medium secure setting. Front Psychiatry [Internet]. 2020 [cited 2020 Oct 8];11:810. Available from: www.frontiersin.org. PubMed PMC

Huband N, Furtado V, Schel S, Eckert M, Cheung N, Bulten E et al. Characteristics and Needs of Long-Stay Forensic Psychiatric Inpatients: A Rapid Review of the Literature [Internet]. Vol. 17, International Journal of Forensic Mental Health. Routledge; 2018 [cited 2020 Oct 13]. pp. 45–60. Available from: https://www.tandfonline.com/doi/full/10.1080/14999013.2017.1405124

Ross T, Querengässer J, Fontao MI, Hoffmann K. Predicting discharge in forensic psychiatry: the legal and psychosocial factors associated with long and short stays in forensic psychiatric hospitals. Int J Law Psychiatry. 2012;35(3):213–21. PubMed

Shah A, Waldron G, Boast N, Coid JW, Ullrich S. Factors associated with length of admission at a medium secure forensic psychiatric unit. J Forens Psychiatry Psychol [Internet]. 2011 Aug [cited 2021 Jul 9];22(4):496–512. Available from: https://www.tandfonline.com/doi/abs/10.1080/14789949.2011.594902

Dima A, Wazir A, Clark-Castillo R, Zakopoulos I, Smith S, Gaughran F. Factors influencing the length of stay in forensic psychiatric settings: a systematic review. BMC Health Serv Res [Internet]. 2024 Dec 1 [cited 2024 Oct 8];24(1):1–17. Available from: https://link.springer.com/article/10.1186/s12913-024-10863-x PubMed PMC

Olagunju AT, Bouskill SL, Olagunju TO, Prat SS, Mamak M, Chaimowitz GA. Absconsion in forensic psychiatric services: a systematic review of literature. CNS Spectr. 2022;27(1):46–57. 10.1017/S1092852920001881. PubMed

Hettema P. Ethical Aspects of Long-Stay Forensic Psychiatric Care. Long-Term Forensic Psychiatric Care [Internet]. 2019 [cited 2021 Jul 22];47–62. Available from: https://link.springer.com/chapter/10.1007/978-3-030-12594-3_5 DOI

Coid J, Kahtan N, Gault S, Cook A, Jarman B. Medium secure forensic psychiatry services: Comparison of seven English health regions. The British Journal of Psychiatry [Internet]. 2001 [cited 2023 Jun 29];178(1):55–61. Available from: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/medium-secure-forensic-psychiatry-services/FAA935128D172ED97AD6F15545222C92 PubMed

Stürner L, Ross T, Querengässer J, Traub HJ. Institutional influence on length of stay in German forensic hospitals: a multilevel analysis of patients with schizophrenia spectrum disorders. Front Psychiatry. 2024;15:1456363. PubMed PMC

Connell C, Seppänen A, Scarpa F, Gosek P, Heizman J, Furtado V. External factors influencing length of stay in forensic services: A European evaluation. Psychiatr Pol [Internet]. 2019 [cited 2024 Dec 6];53(3):673–89. Available from: https://researchportal.helsinki.fi/files/127697115/ENGver673Connell_PsychiatrPol2019v53i3.pdf PubMed

Páv M, Skřivánková P, Wiseman C, Vňuková M, Blatníková Š, Hollý M. Forensic Treatment Services in the Czech Republic: Current State and Future Challenges. Int J Forensic Ment Health [Internet]. 2020 Jul 2 [cited 2021 Jul 7];19(3):269–82. Available from: https://www.tandfonline.com/doi/abs/10.1080/14999013.2020.1732505

Sebalo I, Sebalo Vňuková M, Anders M, Ptáček R, Páv M. Markers of predicting discharge from forensic psychiatric hospitals in Czechia. https://doi.org/101177/00207640241255575 [Internet]. 2024 Jun 6 [cited 2024 Oct 8]; Available from: https://journals.sagepub.com/doi/full/10.1177/00207640241255575 PubMed DOI PMC

Pav M, Skrivankova P. Analysis of forensic mental health care in the Czech Republic – current state and challenges. Eur Psychiatry [Internet]. 2019;56S(S3–S444):190. Available from: http://2019.epa-congress.org/2019/abstracts/abstract-book-2019#.XU2sNI4zbyM

Páv M, Vňuková M, Papežová S, Toman J, ÚSTAVNÍ OCHRANNÁ LÉČENÍ V. ČR 2018–2020 INPATIENT FORENSIC TREATMENT IN THE CZECH REPUBLIC 2018–2020. Čes Slov Psychiatr. 2022;118(1):9–16.

Páv M, Sebalo I, Vňuková M, Pabiánová Š, Málová V, Hollý M, et al. Predicting discharge from long-term forensic treatment: patients characteristics, protective factors, needs and treatment-related factors study in the Czechia. J Forensic Psychiatry Psychol. 2022;33(1):89–111.

Páv M, Sebalo I, Brichcín S, Perkins D. Outcome Evaluation of a Treatment Program for Men with Paraphilic Disorders Convicted of Sexual Offenses: 10-Year Community Follow-up. https://doi.org/101177/0306624X231165416 [Internet]. 2023 May 9 [cited 2023 Aug 3]; Available from: https://journals.sagepub.com/doi/abs/10.1177/0306624X231165416 PubMed

Efron B, Tibshirani RJ. A introduction to the Bootstrap. Boca Raton: Chapman & Hall, 1993.; 1993. 436 p.

Sebalo I, Sebalo Vňuková M, Anders M, Ptáček R, Páv M. Markers of predicting discharge from forensic psychiatric hospitals in Czechia. https://doi.org/101177/00207640241255575 [Internet]. 2024 Jun 6 [cited 2024 Dec 6]; Available from: https://journals.sagepub.com/doi/full/10.1177/00207640241255575 PubMed DOI PMC

Páv M, Vňuková M, Sebalo I. Factors Affecting Length of Inpatient Forensic Stay: Retrospective Study From Czechia. Front Psychiatry [Internet]. 2022 May 4 [cited 2022 Jun 26];13. Available from: /pmc/articles/PMC9114463/. PubMed PMC

Tomlin J, Lega I, Braun P, Kennedy HG, Herrando VT, Barroso R et al. Forensic mental health in europe: some key figures. Soc Psychiatry Psychiatr Epidemiol. 2020. PubMed PMC

Senn D, Bulten E, Tomlin J, Völlm B. A comparison of english and Dutch Long-Stay patients in forensic psychiatric care. Front Psychiatry. 2020;11:574247. PubMed PMC

Weber K, Morier S, Lesaffre L, Menu C, Bertschy P, Herrmann FR, et al. Court-ordered inpatient psychiatric care in switzerland: determinants of length of stay and treatment outcome. Front Psychiatry. 2023;14:1222337. PubMed PMC

Lau S, Brackmann N, Mokros A, Habermeyer E. Aims to reduce coercive measures in forensic inpatient treatment: A 9-Year observational study. Front Psychiatry. 2020;11. PubMed PMC

Farrell C, Brink J. The prevalence and factors associated with antipsychotic polypharmacy in a forensic psychiatric sample. Front Psychiatry. 2020;11:517071. PubMed PMC

O’Neill C, Kelly A, Sinclai H, Kennedy H, Deprivation. Different implications for forensic psychiatric need in urban and rural areas. Soc Psychiatry Psychiatr Epidemiol [Internet]. 2005 Aug 15 [cited 2025 Mar 17];40(7):551–6. Available from: https://link.springer.com/article/10.1007/s00127-005-0919-9 PubMed

Fett AKJ, Lemmers-Jansen ILJ, Krabbendam L. Psychosis and urbanicity: a review of the recent literature from epidemiology to neurourbanism. Curr Opin Psychiatry [Internet]. 2019 May 1 [cited 2025 Mar 17];32(3):232–41. Available from: https://pubmed.ncbi.nlm.nih.gov/30724751/ PubMed PMC

Losert C, Schmauß M, Becker T, Kilian R. Area characteristics and admission rates of people with schizophrenia and affective disorders in a German rural catchment area. Epidemiol Psychiatr Sci [Internet]. 2012 Dec [cited 2025 Mar 17];21(4):371–9. Available from: https://www.cambridge.org/core/journals/epidemiology-and-psychiatric-sciences/article/abs/area-characteristics-and-admission-rates-of-people-with-schizophrenia-and-affective-disorders-in-a-german-rural-catchment-area/BF7E1CA6A4C56276977DA6C5920DE052 PubMed PMC

Seppänen A, Törmänen I, Shaw C, Kennedy H. Modern forensic psychiatric hospital design: Clinical, legal and structural aspects [Internet]. Vol. 12, International Journal of Mental Health Systems. BioMed Central Ltd.; 2018 [cited 2021 May 17]. pp. 1–12. Available from: https://link.springer.com/articles/10.1186/s13033-018-0238-7 PubMed PMC

Andreasson H, Nyman M, Krona H, Meyer L, Anckarsäter H, Nilsson T, et al. Predictors of length of stay in forensic psychiatry: the influence of perceived risk of violence. Int J Law Psychiatry. 2014;37(6):635–42. PubMed

Gosek P, Kotowska J, Rowińska-Garbień E, Bartczak D, Heitzman J. Treatment resistance and prolonged length of stay among schizophrenia inpatients in forensic institutions. Psychiatry Res. 2021;298:113771. PubMed

Taylor JL, Novaco RW, Brown T. Reductions in aggression and violence following cognitive behavioural anger treatment for detained patients with intellectual disabilities. Journal of Intellectual Disability Research [Internet]. 2016 Feb 1 [cited 2024 Dec 6];60(2):126–33. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jir.12220 PubMed

Klapilová K, Demidova LY, Elliott H, Flinton CA, Weiss P, Fedoroff JP. Psychological treatment of problematic sexual interests: cross-country comparison. https://doi.org/101080/0954026120191591353 [Internet]. 2019 Feb 17 [cited 2022 Jul 22];31(2):169–80. Available from: https://www.tandfonline.com/doi/abs/10.1080/09540261.2019.1591353 PubMed

Taxman FS, Smith L. Risk-Need-Responsivity (RNR) classification models: still evolving. Aggress Violent Behav. 2021;59:101459.

Etzler S, Eher R, Rettenberger M. Dynamic Risk Assessment of Sexual Offenders: Validity and Dimensional Structure of the Stable-2007. Assessment [Internet]. 2020 Jun 1 [cited 2025 Mar 18];27(4):822–39. Available from: https://journals.sagepub.com/doi/full/10.1177/1073191118754705 PubMed DOI

Lösel F, Link E, Schmucker M, Bender D, Breuer M, Carl L et al. On the Effectiveness of Sexual Offender Treatment in Prisons: A Comparison of Two Different Evaluation Designs in Routine Practice. Sexual Abuse: Journal of Research and Treatment [Internet]. 2020 Jun 1 [cited 2022 Jun 6];32(4):452–75. Available from: http://journals.sagepub.com/doi/10.1177/1079063219871576 PubMed DOI PMC

Lösel F, Schmucker M. The effectiveness of treatment for sexual offenders: A comprehensive meta-analysis. Journal of Experimental Criminology 2005 1:1 [Internet]. 2005 Apr [cited 2022 Jan 8];1(1):117–46. Available from: https://link.springer.com/article/10.1007/s11292-004-6466-7 DOI

Schmucker M, Lösel F. The effects of sexual offender treatment on recidivism: an international meta-analysis of sound quality evaluations. J Exp Criminol. 2015;11(4):597–630.