Barriers to discharge: A retrospective study of factors associated with stays of longer than 2 years in a French secure hospital unit.

Background: Extended stays in specialist secure hospital units raise ethical concerns. While this topic has been investigated in various countries, there has been little research on it in France.

Aims: We aimed to study the length of stay of patients in the Henri Colin unit, a secure hospital unit in the Paris area and test relationships between length of stay and sociodemographic, clinical and legal features.

Methods: In this records-based retrospective study, we included all 60 inpatients on a census day just prior to the pandemic. We chose a 2-year threshold to define long stay status.

Results: Mean length of stay was just in the long-stay range (756.7 days, SD 1071.2). Over a quarter (17, 28%) of the patients had been hospitalised for more than 2 years and 5 (8%) patients for more than 5 years. In multivariate analysis, legal status and need for seclusion during stay were significantly associated with long-stay status. These results are consistent with international literature, especially as they show the significant interplay between legal and medical aspects in the patients' care pathway.

Conclusion: As the first such study in a specialist medium security hospital unit in France, this study adds to the international evidence on the complexities surrounding extended stays in secure units and underscores the importance of addressing both clinical and legal aspects in the treatment of patients with mental disorders in these settings.