How Long do People Stay at Secure Forensic-Psychiatric Units and What Factors Influence Length of Stay?

Background

Length of stay (LoS) within forensic-psychiatric care is not widely reported and data on the duration of LoS already available is highly variable due to differing factors. Understanding of LoS and the factors which affect it are important to understand as there are implications for patients, clinicians and commissioners.

Aims

1. To determine what is the LoS within secure forensic-psychiatric units.
2. To understand the extrinsic and intrinsic factors that affect LoS in secure forensic-psychiatric units and identify any modifiable factors.

Methods

The research questions were answered using a systematic review approach and results were summarised narratively. Search of the databases PsycINFO, Embase, Medline, CINAHL was carried out in May 2020, looking for data on the LoS in secure units and extrinsic and intrinsic factors which affect LoS. Two authors independently reviewed the full texts of potentially relevant studies to determine eligibility for inclusion. Only studies in English language and access to full texts were included.

Results

A total of 38 publications were identified which met the inclusion criteria and were included in the review. Of the studies 12 contained only LoS data, 15 contained factor data and 11 reported on both. LoS studies reported on UK and International settings, with high secure and medium secure units within the UK. Most studies reported on intrinsic factors.

Conclusion

LoS increases at higher levels of security in secure forensic psychiatric units. Most studies used admission to discharge data as opposed to admission to census data. Similarly, the level of security setting patients are placed in is a factor which contributes to LoS. Extrinsic factors such as the setting, resources available and treatment received all affect LoS. More research is needed on extrinsic factors affecting LoS to consider if these factors are modifiable or not.