title: Prospective study of factors influencing conditional discharge from a forensic hospital: the DUNDRUM-3 programme completion and DUNDRUM-4 recovery structured professional judgement instruments and risk.
abstract: BACKGROUND
  We set out to examine whether structured professional judgement instruments DUNDRUM-3 programme completion (D-3) and DUNDRUM-4 recovery (D-4) scales along with measures of risk, mental state and global function could distinguish between those forensic patients detained in a secure forensic hospital (not guilty by reason of insanity or unfit to stand trial) who were subsequently discharged by a mental health review board. We also examined the interaction between these measures and risk, need for therapeutic security and eventual conditional discharge.
  
  
  METHODS
  A naturalistic observational cohort study was carried out for 56 patients newly eligible for conditional discharge. Patients were rated using the D-3, D-4 and other scales including HCR-20, S-RAMM, START, SAPROF, PANSS and GAF and then observed over a period of twenty three months during which they were considered for conditional discharge by an independent Mental Health Review Board.
  
  
  RESULTS
  The D-3 distinguished which patients were subsequently discharged by the Mental Health Review board (AUC = 0.902, p < 0.001) as did the D-4 (AUC = 0.848, p < 0.001). Item to outcome analysis showed each item of the D-3 and D-4 scales performed significantly better than random. The HCR-20 also distinguished those later discharged (AUC = 0.838, p < 0.001) as did the S-RAMM, START, SAPROF, PANSS and GAF. The D-3 and D-4 scores remained significantly lower (better) for those discharged even when corrected for the HCR-20 total score. Item to outcome analyses and logistic regression analysis showed that the strongest antecedents of discharge were the GAF and the DUNDRUM-3 programme completion scores.
  
  
  CONCLUSIONS
  Structured professional judgement instruments should improve the quality, consistency and transparency of clinical recommendations and decision making at mental health review boards. Further research is required to determine whether the DUNDRUM-3 programme completion and DUNDRUM-4 recovery instruments predict those who are or are not recalled or re-offend after conditional discharge.
authors.affiliation: National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Davoren
authors.forename: Zareena
authors.initials: Z
authors.lastname: Abidin
authors.forename: Leena
authors.initials: L
authors.lastname: Naughton
authors.forename: Olivia
authors.initials: O
authors.lastname: Gibbons
authors.forename: Andrea
authors.initials: A
authors.lastname: Nulty
authors.forename: Brenda
authors.initials: B
authors.lastname: Wright
authors.forename: Harry G
authors.initials: HG
authors.lastname: Kennedy
mesh_terms: D000328:Adult; D015331:Cohort Studies; D057237:Criminals / Q000523:psychology; D003657:Decision Making; D005555:Forensic Psychiatry; D006801:Humans; D007600:Judgment; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011618:Psychotic Disorders / Q000523:psychology*