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Throughout history most societies have assumed a link between mental disorder and violence to others. In recent times there has been increasing concern in the United Kingdom over law and order, specifically the risk of violence, and these issues are now high on the political and mental health agenda. Nurses and staff working in National Health Service Mental Health Service Trusts are the groups most at risk of violence. Many clinical decisions are based on risk. Mental health nurses play a pivotal role in the assessment and management of risk and it is argued that they need to adopt a clear structured approach to violence risk assessment and management, which is evidence-based. The advantages of clinical and actuarial approaches to risk assessment are briefly reviewed and a structured clinical judgement approach is proposed that combines these approaches. A method of linking the assessment process with the management plan via a risk formulation is discussed.

BackgroundThe MacArthur Violence Risk Assessment Study (MacVRAS) in the USA provided strong evidence to support an actuarial approach in community violence risk assessment.AimsTo examine the predictive accuracy of the MacVRAS measures, in addition to structured professional judgement, in a UK sample of patients discharged from in-patient care in the north-west of England.MethodA prospective study of 112 participants assessed pre-discharge and followed up at 24 weeks post-discharge. Pre-discharge measures were compared with prevalence of violent behaviour to determine predictive validity of risk factors.ResultsHistorical measures of risk and measures of psychopathy, impulsiveness and anger were highly predictive of community violence. The more dynamic clinical and risk management factors derived from structured professional judgement (rated at discharge) added significant incremental validity to the historical factors in predicting community violence.ConclusionsAlthough static measures of risk relating to past history and personality make an important contribution to assessment of violence risk, consideration of current dynamic factors relating to illness and risk management significantly improves predictive accuracy.

Purpose. Empirical support for the predictive validity of North American actuarial violence risk assessment tools in Britain is lacking. The purpose of the study was to explore the validity of the Psychopathy Checklist: Screening Version (PCL: SV), Violence Risk Appraisal Guide (VRAG) and the Historical part (H‐10) of the Historical/Risk/Clinical (HCR‐20) scheme, in predicting in‐patient violence in 87 mentally disordered patients in a medium‐secure unit. Methods. Actuarial scores were obtained retrospectively from pre‐admission/ admission case records. The presence/absence, severity and frequency of in‐patient violence was recorded by an independent researcher. The predictive accuracy and associations between predictors and outcome measures were evaluated using correlational analyses, regression procedures and receiver operator characteristics (ROC) analyses. Results. Scores on all three risk assessment tools were significantly higher in the violent cohort. The PCL: SV is the most robust predictor of in‐patient violence, and contributes significantly to the predictive validity of the VRAG and H‐10 scale of the HCR‐20. Conclusions. The PCL: SV appears to be a valid predictor of in‐patient violence within 12 weeks of admission to an English MSU and predictive validity is similar to that reported in North American studies.

Research has been conducted to try to identify risk factors to help predict which patients will be violent during psychiatric hospitalization. Despite the relatively large amount of research conducted, it is difficult to draw any firm conclusions, as the studies vary considerably in study design, methods used, and choice of outcome measures. Studies also tend to focus on risk prediction, even though risk management is the primary aim of clinical practice in mental health services and few studies have focused on a theoretical basis for understanding violence. This study assessed the predictive validity of brief assessment scales in a sample of 94 forensic inpatients who had been inpatient for a median of 521 days, to test the hypotheses that anger regulation problems, interpersonal style, and disturbed mental state would be linked to increased violence risk in a forensic hospital during a hospital stay. The outcome variables for this study were physical violence against another and/or clear threats of physical violence. The results of this study provide support for the hypotheses, and this remained the case after controlling for age, gender, length of stay, and presence of major mental disorder. The findings should not only assist clinicians with assessment and management of risk but also support the reconceptualizing of risk prediction research to reflect the task of clinical risk management.

Violence risk prediction is an inexact science and as such will continue to provoke debate. Clinicians clearly need to be able to demonstrate the rationale behind their decisions on violence risk and much can be learned from recent developments in research on violence risk prediction.

BackgroundInternet based social media websites represent a growing space for interpersonal interaction. Research has been conducted in relation to the potential role of social media in the support of individuals with physical health conditions. However, limited research exists exploring such utilisation by individuals with experience of mental health problems. It could be proposed that access to wider support networks and knowledge could be beneficial for all users, although this positive interpretation has been challenged. The present study focusses on a specific discussion as a case study to assess the role of the website www.twitter.com as a medium for interpersonal communication by individuals with experience of mental disorder and possible source of feedback to mental health service providers.MethodAn electronic search was performed to identify material contributing to an online conversation entitled #dearmentalhealthprofessionals. Output from the search strategy was combined in such a way that repeated material was eliminated and all individual material anonymised. The remaining textual material was reviewed and combined in a thematic analysis to identify common themes of discussion.Results515 unique communications were identified relating to the specified conversation. The majority of the material related to four overarching thematic headings: The impact of diagnosis on personal identity and as a facilitator for accessing care; Balance of power between professional and service user; Therapeutic relationship and developing professional communication; and Support provision through medication, crisis planning, service provision and the wider society. Remaining material was identified as being direct expression of thanks, self-referential in its content relating to the on-going conversation or providing a link to external resources and further discussion.ConclusionsThe present study demonstrates the utility of online social media as both a discursive space in which individuals with experience of mental disorder may share information and develop understanding, and a medium of feedback to mental health service providers. Further research is required to establish potential individual benefit from the utilisation of such networks, its suitability as a means of service provision feedback and the potential role for, and user acceptability of, mental health service providers operating within the space.

Soldier life exists on a continuum of readiness for deployment. Re-entry and reintegration-the return home and reunion with family and community-key the success of the deployment cycle. In current and projected future operations, the Army and society will both bear the burden of this re-entry and re-integration. Programs and procedures in place work towards improving communication, mitigating distress and resolving crises during reentry and reintegration. Key elements include: inclusion of families and communities early into the planning for reentry and reintegration; normalization (non-medicalization of distress); easy access to behavioral health professionals; and education of families on resources and benefits. Through broad collaboration, maximal benefit to the Soldier, family members and society be realized.