Court-ordered inpatient psychiatric care in Switzerland

Determinants of length of stay and treatment outcome

Bibliographic Data

ID15516294
AuthorsKerstin Weber (University of Geneva, corresponding author), Sandrine Morier (University Hospital of Geneva), Lise Lesaffre (0000-0001-9898-720X, University Hospital of Geneva), Christophe Menu, Philippe Bertschy, François R Herrmann (0000-0003-1312-1517, University of Geneva), Pantéleimon Giannakopoulos (0000-0003-4624-7386, University of Geneva)
Year2023
Volume14
Pages1222337-1222337
Publication date2023-10-03
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueFrontiers in Psychiatry (JOURNAL)
Journal identifiersISSN: 1664-0640 • E-ISSN: 1664-0640
PublisherFrontiers Media (PUBLISHER • CH)
DOI10.3389/fpsyt.2023.1222337
PMID37854441
OpenAlexW4387303744
LanguageEN
Citations received3
References cited58

Introduction In several European countries, offenders with decreased or abolished responsibility and high risk of recidivism due to long-lasting mental disorders are compulsory admitted for court-ordered treatments (COT) that take place in high and medium-security hospitals. As a rule, length of stay in these structures is very long implying major restrictions for the inmate and high societal cost. Despite intensive research, the predictors of length of stay and treatment outcome in long stay forensic services is still matter of debate. Methods We report here a detailed analysis of the demographic, psychiatric and offense predictors of length of stay and discharge locations of 204 mentally disordered offenders convicted to COT in a new medium-security forensic psychiatry clinic in Geneva, Switzerland. Kaplan-Meier survival estimates were performed to determine time to release. Length of stay was predicted by Cox regressions, and discharge locations were predicted by multinomial logistic regressions. Results The typical inpatient was a 35-age single male re-offender, submitted to COT after a conviction for physical violence (78.9%) or property violation (64.2%), with drug trafficking (52.9%), in relation to psychotic (67.2%), antisocial or borderline personality disorder (35.8%) with comorbid substance use disorders (60.3%). Sex offenses were found in 24.5% of cases and were associated with Cluster B personality disorders. The median length of stay was of 2.5 years and was independent of demographic variables, severity of crime recidivism and psychiatric diagnosis. Longer COT at admission, and type of offense (in particular drug traffic and sexual violence) predicted longer stays. At discharge, 32.8% of cases were transferred to sheltered educational housing, 23.1% to open low-security wards, while 30.6% returned to regular prisons and 9.7% to their country of origin. Discussion Younger age and conviction for property violation rather than physical violence increased the chances to be discharged to sheltered educational housing. Longer COT at admission, personality disorders, and conviction for sexual offense increased the risk to return to prison. These data suggest that sex offenses determine not only longer stays under COT but also drastically decreases the chance of freedom for inmates with Cluster B personality disorders

Conviction · Forensic psychiatry · Logistic regression · Multinomial logistic regression · Personality · Personality disorders · Psychiatry · Recidivism · Demography · Healthcare Decision-Making and Restraints · Medicine · Psychology · Psychopathy, Forensic Psychiatry, Sexual Offending · Schizophrenia research and treatment

Tools

Open DOIOpen Access