Absconding of patients on acute psychiatric wards

Background

Absconding of patients from acute psychiatric wards poses a significant problem to professional staff and can involve risks for patients and others. Despite research results in the English speaking countries, there is no research on this topic in Germany.

Methods

Naturalistic study of absconders and control group among inpatients in compulsory treatment. Study period: two years. Setting: psychiatric acute unit with an "open-door" policy. Data were collected from case records and official report forms recording absconding incidents. In a prospective study over half a year all absconders were interviewed.

Results

Among compulsory admissions (846 admissions, 11.8% of all admissions) 97 admissions resulted in 148 incidents of absconding involving 72 patients. Typical absconders are younger than 35 years, have a diagnosis of chronic schizophrenia with an alcohol/drug comorbidity, are unmarried, and live on social welfare payments. Only 55.4% of absconders were considered harmful to self or others. 39.3% of all incidents of absconding took place during therapeutic activities outside the ward. The main causes of absconding were conflicts with staff members or patients and rules of absence from the ward considered too restrictive. Only 3 absconders did not return. The most common destination was home or friends or relatives. Some absconders consumed drugs. Two patients attempted suicide. No absconder harmed others, none committed a crime.

Conclusion

Absconding could be minimized through adequate identification of risk to abscond, and better education of staff members in handling conflicts with these patients. Clear and acceptable rules of absence could help. More research is needed.