title: Never ever? Characteristics, outcomes and motivations of patients who abscond or escape: A 5-year review of escapes and absconds from two medium and low secure forensic units.
abstract: BACKGROUND
  Absconds and escapes by psychiatric patients from secure forensic psychiatric settings create public anxiety and are poorly understood.
  
  
  OBJECTIVE
  To describe secure hospital patients who escape from within the secure perimeter or abscond, and test for differences between these groups.
  
  
  METHODS
  Escapes and absconds between 2008 and 2012 from the medium and low secure forensic psychiatric inpatient units of two London National Health Service Trusts were identified through the Trusts' databases. Demographic, offending, mental health and incident data were extracted from records for each.
  
  
  RESULTS
  Seventy-seven incidents, involving 54 patients, were identified over the five years. These were 13 escapes involving 12 patients, representing a rate of 0.04 per 1000 bed days, and 64 absconds involving 42 patients, a rate of 0.26 per 1000 bed days; 15 (28%) patients were absent without leave more than once. Over half of the patients came back voluntarily within 24 hours of leaving. Over 50% of them had drunk alcohol or taken drugs while away from the unit. Escapees were more likely to be transferred prisoners and to have planned their escape, less likely to return to the unit voluntarily and away longer than patients who absconded. Offending was rare during unauthorised leave--just three offences among the 77 incidents; self-harm was more likely. Motives for absconding included: wanting freedom or drink or drugs, family worries and/or dissatisfaction with aspects of treatment.
  
  
  CONCLUSIONS
  Escapes or absconding from secure healthcare units have different characteristics, but may best be prevented by convergent strategies. Relational security is likely to be as important for foiling plans for the former as it is for reducing boredom, building strong family support and managing substance misuse in the latter.
authors.affiliation: Population Health Research Institute, St Georges University of London, Cranmer Terrace, London, SW17 ORE, United Kingdom.
authors.forename: Gillian
authors.initials: G
authors.lastname: Mezey
authors.affiliation: Shaftesbury Clinic, Glenburnie Road, London, SW17 7DJ, United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: Durkin
authors.affiliation: Shaftesbury Clinic, Glenburnie Road, London, SW17 7DJ, United Kingdom.
authors.forename: Liam
authors.initials: L
authors.lastname: Dodge
authors.affiliation: Population Health Research Institute, St Georges University of London, Cranmer Terrace, London, SW17 ORE, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: White
mesh_terms: D000328:Adult; D004924:Escape Reaction; D005260:Female; D005555:Forensic Psychiatry; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008131:London; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D008605:Mental Health Services; D008875:Middle Aged; D009042:Motivation; D010352:Patient Dropouts / Q000523:psychology*; D012637:Security Measures; D016312:Treatment Refusal / Q000523:psychology