Krista A Mosel

Absconding: A review of the literature 1996-2008

Absconding is a significant problem with potential for harm to patients or the general public. The consequences of absconding include physical harm, prolonged treatment time, and substantial economic costs. The aim of this systematic literature review is to synthesize quality literature about absconding from psychiatric facilities, identify gaps in knowledge, and make recommendations for practice. An electronic search yielded 39 journal articles that met the review criteria. Findings demonstrate that a single definition of absconding remains elusive, making the prevalence of absconding difficult to establish. Absconding events are multifactorial, with environmental, psychosocial, and organic aspects. Negative consequences exist including violence, aggression, and self-neglect and harm to self and others. Papers are clustered around the following themes: harm and risk, absconder profiles, absconding rates, and perceptions of nurses and patients. Nursing interventions designed to decrease absconding have been implemented with success, but only in a few studies and in Australia, none have been reported in the literature to date. Further research is required to identify appropriate nursing-based interventions that may prove useful in reducing the risk of absconding.

The profile of absconding psychiatric inpatients in Australia

AIMS AND OBJECTIVES The purpose of this study was to examine absconding behaviour (a patient leaving the hospital without permission) in acute and rehabilitation wards of one Australian psychiatric institution to describe the characteristics of the absconding patient and these events. BACKGROUND Absconding is a significant issue in psychiatric inpatient settings, with risks that include patient harm, aggression and violence. In spite of this, limited research has been conducted in Australia on patients who abscond while receiving psychiatric care. DESIGN The study was a retrospective descriptive analysis. METHOD Absconding events from three acute and seven rehabilitation wards over a 12-month period were studied. RESULTS The rate of absconding events by detained patients was 20.82%. Gender was not significantly associated with absconding, although 61.19% of those who absconded were men diagnosed with schizophrenic disorders. Over half of acute care patients who absconded left during their first 21-day detention order. More than half of absconding events were by patients that absconded more than once. There was limited support for the efficacy of locking ward doors. Age and diagnosis emerged as particularly important factors to consider. DISCUSSION The study revealed that men are not more likely to abscond than women, that locking ward doors does not deter the determined absconders and that once a person has absconded, they are more likely to do so again. Younger patients and those with a schizophrenic disorder may be particularly likely to abscond. There also appears to be a link between continuing detention orders and an absconding event. CONCLUSIONS Findings provide new data about the profile of absconding patients in Australia. Exploration of the reasons why patients abscond and why many do so repeatedly warrants further investigation. RELEVANCE TO CLINICAL PRACTICE Risk management approaches taking into account factors associated with absconding could be trialled to reduce the incidence of absconding in psychiatric inpatient settings.

Managing risk: clinical decision-making in mental health services.

Risk assessment and management is a major component of contemporary mental health practice. Risk assessment in health care exists within contemporary perspectives of management and risk aversive practices in health care. This has led to much discussion about the best approach to assessing possible risks posed by people with mental health problems. In addition, researchers and commentators have expressed concern that clinical practice is being dominated by managerial models of risk management at the expense of meeting the patients health and social care needs. The purpose of the present study is to investigate the risk assessment practices of a multidisciplinary mental health service. Findings indicate that mental health professionals draw on both managerial and therapeutic approaches to risk management, integrating these approaches into their clinical practice. Rather than being dominated by managerial concerns regarding risk, the participants demonstrate professional autonomy and concern for the needs of their clients.

Retrospective analysis of absconding behaviour by acute care consumers in one psychiatric hospital campus in Australia.

Absconding is increasingly being recognized as a problem within mental health settings with significant risks for consumers. This study examines absconding behaviours across three acute care wards within an Australian psychiatric hospital campus over a 12-month period. A descriptive statistical analysis determined the rate of absconding from 49 consumers who absconded 64 times. The absconding rate was 13.33% (absconding events), with most absconding events arising from males diagnosed with schizophrenia (57.14%) aged between 20 and 29 years, and with 62.50% of absconding events occurring whilst consumers were on their first 21-day detention order. Nearly half of all absconding events were by consumers who had absconded previously, with the highest proportion of events occurring during nursing handover. A profile of people who abscond, time of day of absconding, legal status and repeated absconding behaviours are described. The emergent profile of consumers who absconded within this study bears some similarities to that described in overseas research, although in this study consumers were slightly older and 25% of absconders were female. Of particular interest are findings that identify the timings of absconding events in relation to a consumers legal status. Implications for practice, including assessment of risk of absconding and management, are considered.

Education on physical restraint reduction in dementia care: a review of the literature.

Dementia is a priority area for all countries as populations age and dementia prevalence increases. The use of physical restraint is a possible clinical practice for persons with dementia across settings when behaviours indicate a perceived need. Indeed, this may be the first choice in practice, occurring in part because of lack of education, safety concerns, perceived costs and staffing issues. This article reviews the literature on the issues surrounding, and use of, physical restraint for people with dementia, highlighting the rationales for use and the benefits and barriers to physical restraint. Recommendations include the importance of education and policy to reduce or eliminate physical restraint of persons with dementia to overcome identified barriers at the individual, cultural and organizational levels. An educational programme from the literature review is proposed specific to the reduction or elimination of physical restraint.

Five-year review of absconding in three acute psychiatric inpatient wards in Australia

Absconding, where patients under an involuntary mental health order leave hospital without permission, can result in patient harm and emotional and professional implications for nursing staff. However, Australian data to drive nursing interventions remain sparse. The purpose of this retrospective study was to investigate absconding in three acute care wards from January 2006 to June 2010, in order to determine absconding rates, compare patients who did and did not abscond, and to examine incidents. The absconding rate was 17.22 incidents per 100 involuntary admissions (12.09% of patients), with no significant change over time. Being male, young, diagnosed with a schizophrenia or substance-use disorder, and having a longer hospital stay were predictive of absconding. Aboriginal and Torres Strait Islander patients had higher odds of absconding than Caucasian Australians. Over 25% of absconding patients did so multiple times. Patients absconded early in admission. More incidents occurred earlier in the year, during summer and autumn, and later in the week, and few incidents occurred early in the morning. Almost 60% of incidents lasted ≤24 hours. Formulation of prospective interventions considering population demographic factors and person-specific concerns are required for evidence-based nursing management of the risks of absconding and effective incident handling when they do occur.

Consumer and carer consultants in mental health: The formation of their role identity

Abstract Following the introduction of the first National Mental Health Plan in 1992 consumer participation was and continues to be identified as a key component of the reform of Australia’s mental health services. One strategy to achieve participation has been the creation of the role of consumer and carer consultants (CCCs) who have been employed in public mental health services since the early 1990s. Despite over two decades of service by CCCs there seems to be little consensus between the CCCs and mental health professionals regarding the roles and function of these positions. This qualitative study sought to explore the question of ‘what is the role of consultants?’ from the perspective of CCCs, focusing in particular on the formation of CCCs’ role identity. Four themes were identified, namely: role motivation; role preparation; role practice/focus; and role ambiguity/conflict. This paper explores these themes and their implications, and finally makes recommendations regarding clinical practice.

An exploration of absconding behaviours from culturally and linguistically diverse psychiatric hospital patients in Australia

Psychiatric morbidity among minority populations is believed to be higher than in the general population due to unmet healthcare needs and where significant health inequalities are experienced within culturally and linguistically diverse (CALD) populations. Absconding (psychiatric patients running away from hospital) is a high-risk event and has been linked to harm to self and others. Very little research has been conducted into the absconding behaviours of people from a CALD background. In this study, a population of in-patients from a CALD background who absconded from a psychiatric hospital was examined. Areas of analysis included identification of CALD patients who absconded more than once, diagnosis, age, ward of absconding and time of absconding events. Approximately one-in-six patients from a CALD background absconded in the present study, indicating that absconding is a problem of sufficient extent to warrant greater attention. The authors conclude that more efforts should be made to restructure pathways to mental health care needs among CALD populations.

A retrospective analysis of absconding behaviours by psychiatric inpatients in one psychiatric hospital campus in Australia

There has been minimal research within Australia seeking to investigate the absconding behaviours of psychiatric patients. The rate of absconding has not been established in different Australian psychiatric facilities, and little has been done to define the profile of an absconder in an Australian setting. Exploring this phenomenon in detail will provide a fuller understanding of absconding and facilitate appropriate nursing interventions.