Better communication and patient-centered psychiatric care are key to reducing escape incidents

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Patients flee from inpatient mental health facilities because they experience bad news or conflict, or because they have certain everyday things to do, a study by Flinders University found that results in fewer than 2 in 100 patients leaving care.

Image source: Flinders University

The researchers, led by Professor Emeritus Eimear Muir-Cochrane of the College of Nursing and Health Sciences at Flinders University, say better communication and patient-centered care are key to reducing a patient’s need to flee or to leave without permission while simultaneously using antipsychotics or sedatives known as chemical restraint.

“Mental health care in Australia is dominated by the risk the patient poses to the outside world or to himself rather than individual needs,” said Professor Muir-Cochrane, past president of the Australian College of Mental Health Nursing.

“While safety is of course important, the human rights of people in mental health facilities must be respected, and we can do this by meeting their needs with empathy and communication.”

Professor Muir-Cochrane, along with colleagues from Flinders University, Dr. Amanda Muller and Dr. Candice Oster, anonymized data from 11 psychiatric wards in an Australian metropolis between January 2016 and June 2018.

During this time, 995 escape events were reported by 488 patients, which corresponds to a rate of 1.6 events per 100 admissions.

Most patients left open, unlocked wards, many simply did not return from approved leave or returned late with only two events occurring on the three locked wards included in the data. “

Eimear Muir-Cochrane, Professor Emeritus, College of Nursing and Health Sciences at Flinders University

Men fled more often than women, while indigenous Australians were responsible for a quarter of all flight incidents. Nearly 80 percent of the patients who fled were diagnosed with schizophrenia or other primary psychotic disorders, with most being involuntarily admitted to inpatient treatment.

In addition to the number of events, the researchers also had notes from the nursing staff that shed light on why the patient left the facility.

The study identified two main themes to explain why patients left the facility, one categorized as “something to do” and the other as “something has changed”.

“In some cases, people chose to flee simply because they had the opportunity, such as an open door or poor security, while others left because they wanted something specific,” says Professor Muir-Cochrane.

“On the other hand, certain patients left the clinic because something had changed in their treatment, because they received bad news, or because of a conflict between them and other patients or staff.”

While this is just a snapshot of mental health patients across Australia, researchers say understanding why people are leaving mental health treatment can help learn how the system can improve.

“We need a comprehensive, patient-centered system with intensive support from nurses and, if necessary, family, as well as structured ward activities to avoid boredom and encourage patients to stay connected to their support system outside of the hospital,” says Professor Muir-Cochrane.

“We need to stop viewing patients in mental health facilities as just a safety risk, but as patients with needs that, if not met, lead to poor outcomes, just like any other health patient.”

Source:

Journal reference:

Muir-Cochrane, E., et al. (2021) Absconding: A Qualitative Perspective of Patients Leaving Inpatient Psychiatric Care. International journal of mental health care. doi.org/10.1111/inm.12863.