Analysing length of stay disparities in inpatient forensic psychiatric care: a cross-sectional study in Czechia

Area of Science:

• Forensic Psychiatry
• Healthcare Management
• Mental Health Services Research

Background:

• Length of stay (LoS) is a key metric for inpatient forensic treatment effectiveness.
• Significant inter-hospital variations in LoS exist within Czechia.
• Analysis of sociodemographic and treatment data is needed to understand these differences.

Purpose of the Study:

• To analyze inter-hospital differences in inpatient forensic length of stay (LoS) in Czechia.
• To identify sociodemographic and treatment-related factors influencing LoS.
• To provide data for improving forensic psychiatric care policy and practice.

Main Methods:

• Descriptive parameters collected from 841 forensic inpatients across 13 Czech hospitals.
• Follow-up data collected at 6 months (N=800).
• Linear regression analyses and resampling used on data from 8 hospitals (>50 patients) to identify LoS variations linked to offense, diagnosis, and treatment.

Main Results:

• The cohort (predominantly males, mean age 41.84) had long-term mental health histories (mean diagnosis length 13.2 years).
• Violent offenses were common, with psychotic, substance use, or intellectual disability diagnoses predominating.
• Mean LoS was 1,327.58 days, with significant variations observed between diagnostic groups and hospitals; substance abuse (760 days), psychotic disorders (1490 days), and intellectual disabilities (2441 days).

Conclusions:

• Significant inter-hospital variations in LoS were found, influenced by index offenses, diagnoses, and treatment programs.
• Unrecognized institutional factors likely contribute to these LoS disparities.
• Standardized guidelines and regular outcome evaluations are essential for balancing LoS and improving forensic psychiatric care quality in Czechia.