Severe Psychopathology,but not Violence Risk,Predicts Length of Stay in Adolescent Forensic Inpatient Care

Abstract

Forensic psychiatric inpatient units for minors are not widespread, nor is the associated research. The treatment is generally high-cost and lengthy, despite the recommendation to keep inpatient care as brief as possible. Our objective was to identify factors that predict length of stay (LOS) in such treatment. Because society might expect forensic inpatient care to “protect the public” in addition to treating the patient, we put a special emphasis on whether risk of violence prolongs care. The retrospective study comprised patients from one of two Finland's forensic psychiatric units for minors treated since its inception in 2003–2019 (n = 313). The vast majority suffered from serious mental disorders, were affected by adverse background factors such as parenting problems, and had a history or violent and/or criminal behavior. Excluding two outliers, the median LOS was 133 days (IQR = 213; range 33–1472). In a bivariate and a subsequent multivariate analysis, a longer LOS was predicted primarily by indicators of severe psychopathology (e.g., BPRS score and diagnosis of a psychotic disorder), but not by predicted risk of violence nor by any of the studied adverse background factors. This may suggest that the treatment focus is appropriately placed on treating the patient, and violent and noncompliant behaviors arising from circumstances respond better to inpatient care than that rooted in very profound psychopathology. Future research should explore the outcomes of adolescent forensic inpatient care in follow-up designs.