Violence after discharge from forensic units in the safe pilot study: a prospective study with matched pair design

This paper reports on a prospective naturalistic study of violent recidivism after discharge from forensic mental health. Main aims were to find predictors of violence and to test the feasibility of a matched pair design for this purpose.

Patients from the Safe pilot project (n=18) and a group of controls (n=18) were matched on 10 variables, such as diagnosis, seriousness of violence, setting after discharge, and risk management plans. All the Safe pilot patients had been through repeated measurement of dynamic risk factors of violence the year before discharge to develop efficient risk management plans for use after discharge. We wanted to test whether violent recidivism during follow-up would be lower and less serious in the Safe pilot group.

We found no significant between-group difference concerning number of patients with violent recidivism. However, the Safe pilot patients had significantly lower rates of violence and fewer severe violent episodes. In the control group, there was a significant association between a high number of risk management plans and high rates of violence. There was a statistical trend for the opposite association in the Safe pilot group.

We discuss this in terms of a possible gap between the development and implementation of plans.