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Tijdschrift voor Psychiatrie 56 (2014) 4, 237 - 246

New research

‘I’ll serve my time…’ II. A replication study of recidivism in patients with a one-year hospital order

M.J. Nowak, M.A. Nugter

background In the Netherlands a one-year hospital order is often imposed on forensic patients with a psychotic disorder. The purpose of the order is to reduce the patient’s violence behaviour by forcing him/her to receive medical treatment for a year. A pilot study showed that the recidivism rate for this group, following discharge, was relatively high. Patients who re-offended had relatively high hcr-20 scores and were more often involved in incidents during treatment than patients who had not re-offended.
aim To replicate the findings of the pilot study and to compare the recidivism rate of this group to the recidivism rate of patients who had been given a detention order for a longer time with possibilties for prolongation (‘tbs’).
method The study involved 95 patients with a psychotic disorder who had been treated in an fpa (Forensic Psychiatric Clinic) by reason of a one-year hospital order or a detention order for an unspecified time. Hospital records were consulted in order to complete the hkt-30 and the pcl-r and to check how many incidents had occurred during each patient’s treatment. The HKT-30 is a dutch version of the HCR-20. The results were counted at a later date by persons not informed about the outcome. After the hospital records had been checked, the recidivism figures were obtained from the Information Service of the Ministry of Justice.
results Of the patients subject to the one-year hospital order 43.5% reoffended following discharge. Recidivism by patients who had been given the longer-term detention order was significantly lower, namely 23.1%. The seriousness of the offences committed following discharge differed significantly from the offence for which they were originally charged/convicted. The hkt-30 and factor 2 of the pcl-r predicted the possibility of recidivism, but the number of violent incidents that occurred on the ward did not.
conclusion Our findings indicate that the recidivism among patients subject to a one-year hospital order is relatively high compared to the rate among patients who had received a longer-term detention order. The most likely explanation for this difference is that the hospital order was imposed for a shorter period.

keywords HCR -20, HKT-30, incidents, PCL-R, recidivism, one year hospital order