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      Who is reported missing from Canadian hospitals and mental health units?

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      Policing: An International Journal
      Emerald

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          Abstract

          Purpose

          International literature on missing persons suggests that a significant volume of missing person cases originate from hospitals and mental health units, resulting in considerable costs and resource demands on both police and health sectors (e.g., Bartholomew et al., 2009; Sowerby and Thomas, 2017). In the Canadian context, however, very little is known about patients reported missing from these locations – a knowledge deficit with profound implications in terms of identifying and addressing risk factors that contribute to this phenomenon. The present study is one such preliminary attempt to try to fill a significant research and policy gap.

          Design/methodology/approach

          The authors draw on data from a sample of 8,261 closed missing person reports from a Canadian municipal police service over a five-year period (2013–2018). Using multiple logistic regression, the authors identify, among other factors, who is most likely to be reported missing from these locations.

          Findings

          Results reveal that several factors, such as mental disabilities, senility, mental illness and addiction, are significantly related to this phenomenon. In light of these findings, the authors suggest that there is a need to develop comprehensive strategies and policies involving several stakeholders, such as health care and social service organizations, as well as the police.

          Originality/value

          Each year, thousands of people go missing in Canada with a large number being reported from hospitals and mental health units, which can be burdensome for the police and health sectors in terms of human and financial resource allocation. Yet, very little is known about patients reported missing from health services – a knowledge deficit with profound implications in terms of identifying and addressing risk factors that contribute to this phenomenon. This manuscript seeks to remedy this gap in Canadian missing persons literature by exploring who goes missing from hospitals and mental health units.

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          Most cited references28

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          Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey

          Background Suicide prevention by mental health services requires an awareness of the antecedents of suicide amongst high risk groups such as psychiatric in-patients. The goal of this study was to describe the social and clinical characteristics of people who had absconded from an in-patient psychiatric ward prior to suicide, including aspects of the clinical care they received. Methods We carried out a national clinical survey based on a 10-year (1997-2006) sample of people in England and Wales who had died by suicide. Detailed data were collected on those who had been in contact with mental health services in the year before death. Results There were 1,851 cases of suicide by current psychiatric in-patients, 14% of all patient suicides. 1,292 (70%) occurred off the ward. Four hundred and sixty-nine of these patients died after absconding from the ward, representing 25% of all in-patient suicides and 38% of those that occurred off the ward. Absconding suicides were characterised by being young, unemployed and homeless compared to those who were off the ward with staff agreement. Schizophrenia was the most common diagnosis, and rates of previous violence and substance misuse were high. Absconders were proportionally more likely than in-patients on agreed leave to have been legally detained for treatment, non-compliant with medication, and to have died in the first week of admission. Whilst absconding patients were significantly more likely to have been under a high level of observation, clinicians reported more problems in observation due to either the ward design or other patients on the ward. Conclusion Measures that may prevent absconding and subsequent suicide amongst in-patients might include tighter control of ward exits, and more intensive observation of patients, particularly in the early days of admission. Improving the ward environment to provide a supportive and less intimidating experience may contribute to reduced risk.
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            Characteristics and motivations of absconders from forensic mental health services: a case-control study

            Background Absconding from hospital is a significant health and security issue within psychiatric facilities that can have considerable adverse effects on patients, their family members and care providers, as well as the wider community. Several studies have documented correlates associated with absconding events among general psychiatric samples; however, few studies have examined this phenomenon within samples of forensic patients where the perception of threat to public safety in the event of an unauthorized absence from hospital is often higher. Methods We investigate the frequency, timing, and determinants of absconding events among a sample of forensic psychiatric patients over a 24-month period, and compare patients who abscond to a control group matched along several sociodemographic and clinical dimensions. We explore, in a qualitative manner, patients’ motives for absconding. Results Fifty-seven patients were responsible for 102 incidents of absconding during the two year study window. Forensic patients who absconded from hospital were more likely to have a history of absconding attempts, a diagnosed substance use disorder, as well as score higher on a structured professional violence risk assessment measure. Only one of the absconding events identified included an incident of minor violence, and very few included the commission of other illegal behaviors (with the exception of substance use). The most common reported motive for absconding was a sense of boredom or frustration. Conclusions Using an inclusive definition of absconding, we found that absconding events were generally of brief duration, and that no member of the public was harmed by patients who absconded. Findings surrounding the motivations of absconders suggest that improvements in therapeutic communication between patients and clinical teams could help to reduce the occurrence of absconding events.
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              Determinants of absconding by patients on acute psychiatric wards.

              Determinants of absconding by patients on acute psychiatric wards Absconding by patients from acute psychiatric wards is a high risk behaviour and has been linked to harm to self and others. Previous research on the characteristics of absconders has been overly reliant on officially generated statistics and small numbers of variables, limiting the conclusions that may be drawn. This paper reports on a prospective study of absconders from 12 acute admission wards in three English National Health Service Trusts over 5 months, compared to a control group matched for ward. Extensive data on absconder and control characteristics were collected from case records and from nursing staff. Absconders were significantly different from controls in many respects. Absconding is linked to other forms of non-compliant patient behaviour, e.g. medication refusal and involvement in violent incidents. Significant variations in the rates of absconding were found between different wards, and between different consultant psychiatrists. Predictive factors were identified by logistic regression. Study in the diverse fields of non-compliance should be brought together as these phenomena are likely to be interrelated. Further investigation is required to determine exactly what it is that consultant psychiatrists and ward nurses do that affects absconding rates.
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                Author and article information

                Contributors
                Journal
                Policing: An International Journal
                PIJPSM
                Emerald
                1363-951X
                May 10 2020
                June 08 2020
                May 10 2020
                June 08 2020
                : 43
                : 3
                : 525-540
                Article
                10.1108/PIJPSM-12-2019-0191
                610ca721-a999-4e1c-8c25-e169eca9cf80
                © 2020

                https://www.emerald.com/insight/site-policies

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