Evidence map›Paper›PMID 26729842›Full record

SynthesisThe British journal of psychiatry : the journal of mental science2016

Patient outcomes following discharge from secure psychiatric hospitals: systematic review and meta-analysis.

Seena Fazel, Zuzanna Fimińska, Christopher Cocks, Jeremy Coid

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The British journal of psychiatry : the journal of mental science, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
47citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

47 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Article
  5. Article
  6. Improving risk assessment in forensic mental health: Temporal validation and clinical refinement of the FoVOx risk tool.European psychiatry : the journal of the Association of European Psychiatrists · 2026
    Article
  7. Article
  8. Review
  9. Article
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  11. International developments in the provision of recovery-oriented care in forensic mental health services.World psychiatry : official journal of the World Psychiatric Association (WPA) · 2025
    Article
  12. Article
  13. Factors associated with length of stay in medium secure units: A realist review.Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists · 2024
    Review
  14. Article
  15. Article
  16. Article
  17. Article
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  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Seena FazelSeena Fazel, MD, Zuzanna Fimińska, MSc, University of Oxford, Oxford, UK; Christopher Cocks, MD, Department of Psychiatry, University of New South Wales, Sydney, Australia; Jeremy Coid, MD, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, UK seena.fazel@psych.ox.ac.uk.
Zuzanna FimińskaSeena Fazel, MD, Zuzanna Fimińska, MSc, University of Oxford, Oxford, UK; Christopher Cocks, MD, Department of Psychiatry, University of New South Wales, Sydney, Australia; Jeremy Coid, MD, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, UK.
Christopher CocksSeena Fazel, MD, Zuzanna Fimińska, MSc, University of Oxford, Oxford, UK; Christopher Cocks, MD, Department of Psychiatry, University of New South Wales, Sydney, Australia; Jeremy Coid, MD, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, UK.
Jeremy CoidSeena Fazel, MD, Zuzanna Fimińska, MSc, University of Oxford, Oxford, UK; Christopher Cocks, MD, Department of Psychiatry, University of New South Wales, Sydney, Australia; Jeremy Coid, MD, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, UK.

Funding

Wellcome Trust 095806
6 · The paper itself

Abstract

backgroundSecure hospitals are a high-cost, low-volume service consuming around a fifth of the overall mental health budget in England and Wales.

aimsA systematic review and meta-analysis of adverse outcomes after discharge along with a comparison with rates in other clinical and forensic groups in order to inform public health and policy.

methodWe searched for primary studies that followed patients discharged from a secure hospital, and reported mortality, readmissions or reconvictions. We determined crude rates for all adverse outcomes.

resultsIn total, 35 studies from 10 countries were included, involving 12 056 patients out of which 53% were violent offenders. The crude death rate for all-cause mortality was 1538 per 100 000 person-years (95% CI 1175-1901). For suicide, the crude death rate was 325 per 100 000 person-years (95% CI 235-415). The readmission rate was 7208 per 100 000 person-years (95% CI 5916-8500). Crude reoffending rates were 4484 per 100 000 person-years (95% CI 3679-5287), with lower rates in more recent studies.

conclusionsThere is some evidence that patients discharged from forensic psychiatric services have lower offending outcomes than many comparative groups. Services could consider improving interventions aimed at reducing premature mortality, particularly suicide, in discharged patients.

Indexed as

Hospitals, PsychiatricCriminalsEnglandHumansMental DisordersMortalityPatient DischargePatient ReadmissionSuicideWales

Identifiers

PMID26729842
PMCPMC4698562

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.