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Violence after discharge from forensic units in the safe pilot study: a prospective study with matched pair design

Authors Bjørkly S, Wærstad JM, Selmer LE, Wærp J, Bjørnstad M, Leinslie JV, Eidhammer G, Douglas KS

Received 3 May 2019

Accepted for publication 5 July 2019

Published 28 August 2019 Volume 2019:12 Pages 755—766

DOI https://doi.org/10.2147/PRBM.S214270

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Melinda Thomas

Peer reviewer comments 2

Editor who approved publication: Professor Mei-chun Cheung


Stål Bjørkly,1,2 Jon Magnus Wærstad,1 Lars Erik Selmer,1 Johnny Wærp,1 Martin Bjørnstad,1 John Vegard Leinslie,1 Gunnar Eidhammer,1 Kevin S Douglas1,3,4

1Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital-HF, Oslo N-0320, Norway; 2Faculty of Health and Social Sciences, Molde University College, Molde N-6402, Norway; 3Department of Psychology, Simon Fraser University, Burnaby V5A 1S6, BC, Canada; 4Centre for Research and Education in Forensic Psychiatry, Bergen Health Trust, Bergen 5021, Norway

Correspondence: Stål Bjørkly
Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital-HF, PO Box 2110, Molde 6402, Norway
Tel +47 4 784 9800
Fax +47 7 121 4100
Email stal.bjorkly@himolde.no

Objective: This paper reports on a prospective naturalistic study of violent recidivism after discharge from forensic mental health. Main aims were to find predictors of violence and to test the feasibility of a matched pair design for this purpose.
Methods: Patients from the Safe pilot project (n=18) and a group of controls (n=18) were matched on 10 variables, such as diagnosis, seriousness of violence, setting after discharge, and risk management plans. All the Safe pilot patients had been through repeated measurement of dynamic risk factors of violence the year before discharge to develop efficient risk management plans for use after discharge. We wanted to test whether violent recidivism during follow-up would be lower and less serious in the Safe pilot group.
Results: We found no significant between-group difference concerning number of patients with violent recidivism. However, the Safe pilot patients had significantly lower rates of violence and fewer severe violent episodes. In the control group, there was a significant association between a high number of risk management plans and high rates of violence. There was a statistical trend for the opposite association in the Safe pilot group.
Conclusion: We discuss this in terms of a possible gap between the development and implementation of plans.

Keywords: forensic mental health, discharge, violence, matched pair

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