The demand for forensic psychiatric beds is increasing, while many individuals are “stuck” in the system. Index offense severity and other legal considerations are associated with longer forensic stays but factors amenable to change such as symptoms of mental illness and aggression may also influence forensic decisions. We examined forensic review board decisions over time among 89 men admitted to a high-security forensic hospital. Almost half received a disposition to remain at their first hearing. Overall, dispositions were not associated with violence risk. The odds of a disposition to remain were higher for men with more in-hospital assaults and higher scores on a measure of clinical factors. Dispositions changed over time and this change was sensitive to clinical factors. We conclude that decisions were consistent with a cascading system of loosening security over time. Further longitudinal research following large samples through the forensic system is recommended.

中文翻译：

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临床因素变化对高安全性法医监护处置的影响

对法医精神病床的需求正在增加，而许多人被“困”在系统中。指数犯罪严重程度和其他法律考虑与更长的法医停留时间相关，但可以改变的因素，例如精神疾病和攻击性的症状也可能影响法医决定。我们检查了法医审查委员会在一段时间内对高安全性法医医院收治的 89 名男性的决定。几乎一半的人同意留在他们的第一次听证会上。总体而言，处置与暴力风险无关。住院攻击次数较多且临床因素得分较高的男性倾向于留下来的几率更高。性格随时间而变化，这种变化对临床因素很敏感。我们得出的结论是，决策与随着时间的推移放松安全性的级联系统是一致的。建议通过法医系统对大样本进行进一步的纵向研究。