A review of published independent inquiries in England into psychiatric patient homicide, 1995–2010

Crichton, John

doi:10.1080/14789949.2011.617832

Cited by 15 publications

(8 citation statements)

References 18 publications

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“…70 This expectation is not as high in other medical specialties, in which the expectation that the doctor will identify the individual patient who will have an adverse event is not a primary issue whereas psychiatry, in many countries such as the UK, has developed a culture of inquiries. 71 A second and related implication is that these tools are not sufficient on their own for the purposes of risk assessment. In some criminal justice systems, expert testimony commonly use scores from these instruments in a simplistic way to estimate an individual's risk of serious repeat offending.…”

Section: Discussionmentioning

confidence: 99%

Use of risk assessment instruments to predict violence and antisocial behaviour in 73 samples involving 24 827 people: systematic review and meta-analysis

Fazel

Singh

Doll

et al. 2012

BMJ

421

321

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Objective To investigate the predictive validity of tools commonly used to assess the risk of violence, sexual, and criminal behaviour.Design Systematic review and tabular meta-analysis of replication studies following PRISMA guidelines.Data sources PsycINFO, Embase, Medline, and United States Criminal Justice Reference Service Abstracts. Review methodsWe included replication studies from 1 January 1995 to 1 January 2011 if they provided contingency data for the offending outcome that the tools were designed to predict. We calculated the diagnostic odds ratio, sensitivity, specificity, area under the curve, positive predictive value, negative predictive value, the number needed to detain to prevent one offence, as well as a novel performance indicator-the number safely discharged. We investigated potential sources of heterogeneity using metaregression and subgroup analyses.Results Risk assessments were conducted on 73 samples comprising 24 847 participants from 13 countries, of whom 5879 (23.7%) offended over an average of 49.6 months. When used to predict violent offending, risk assessment tools produced low to moderate positive predictive values (median 41%, interquartile range 27-60%) and higher negative predictive values (91%, 81-95%), and a corresponding median number needed to detain of 2 (2-4) and number safely discharged of 10 (4-18). Instruments designed to predict violent offending performed better than those aimed at predicting sexual or general crime.Conclusions Although risk assessment tools are widely used in clinical and criminal justice settings, their predictive accuracy varies depending on how they are used. They seem to identify low risk individuals with high levels of accuracy, but their use as sole determinants of detention, sentencing, and release is not supported by the current evidence. Further research is needed to examine their contribution to treatment and management.

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Section: Discussionmentioning

confidence: 99%

Use of risk assessment instruments to predict violence and antisocial behaviour in 73 samples involving 24 827 people: systematic review and meta-analysis

Fazel

Singh

Doll

et al. 2012

BMJ

421

321

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“…It is also reasonable for the family of a victim to expect an explanation, acknowledgement of 35 and apologies for any failings in care and communication in a timely and sensitive manner. 1,36,37 This study has highlighted the potential neglect of families during inquiry processes in New Zealand.…”

Section: Discussionmentioning

confidence: 99%

Families of victims of homicide: qualitative study of their experiences with mental health inquiries

Merry

Paterson

et al. 2020

BJPsych open

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Background Investigations may be undertaken into mental healthcare related homicides to ascertain if lessons can be learned to prevent the chance of recurrence. Families of victims are variably involved in serious incident reviews. Their perspectives on the inquiry process have rarely been studied. Aims To explore the experiences of investigative processes from the perspectives of family members of homicide victims killed by a mental health patient to better inform the process of conducting inquiries. Method The study design was informed by interpretive description methodology. Semi-structured interviews were conducted with five families whose loved one had been killed by a mental health patient and where there had been a subsequent inquiry process in New Zealand. Data were analysed using an inductive approach. Results Families in this study felt excluded, marginalised and disempowered by mental health inquires. The data highlight these families’ perspectives, particularly on the importance of a clear process of inquiry, and of actions by healthcare providers that indicate restorative intent. Conclusions Families in this study were united in reporting that they felt excluded from mental health inquiries. We suggest that the inclusion of families’ perspectives should be a key consideration in the conduct of mental health inquiries. There may be benefit from inquiries that communicate a clear process of investigation that reflects restorative intent, acknowledges victims, provides appropriate apologies and gives families opportunities to contribute.

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“…Those that fund our services complain that too many are detained, 19 while removing funding from objective research. 20 Inquires 21 continue to recommend interventions that do not work – case management, 22 risk assessment and community treatment orders 23 – and themselves can fuel narrative fallacies. 24 Through our overvalued ideas regarding risk assessment, forensic services are left caring for a tiny percentage of mentally disordered offenders, who we dare not part company with, and at vast expense.…”

Section: The Consequences Of Ignoring These Limitationsmentioning

confidence: 99%

The HCR-20 and violence risk assessment – will a peak of inflated expectations turn to a trough of disillusionment?

Silva

2020

BJPsych Bull

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Summary The HCR-20 has taken on a life of its own. In forensic services it has been elevated from helpful aide-mémoire into a prophetic tool worthy of Nostradamus himself. Almost every outcome is interpreted through it. Despite the evidence of its limited utility, the difficulties of predicting rare events, the narrative fallacies and other heuristic biases it creates, and the massive opportunity costs it entails, commissioners and services alike mandate its use. Yet in routine practice the problems are not acknowledged, multiple conflicts of interest lie unobserved and other opportunities are neglected.

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A review of published independent inquiries in England into psychiatric patient homicide, 1995–2010

Cited by 15 publications

References 18 publications

Use of risk assessment instruments to predict violence and antisocial behaviour in 73 samples involving 24 827 people: systematic review and meta-analysis

Use of risk assessment instruments to predict violence and antisocial behaviour in 73 samples involving 24 827 people: systematic review and meta-analysis

Families of victims of homicide: qualitative study of their experiences with mental health inquiries

The HCR-20 and violence risk assessment – will a peak of inflated expectations turn to a trough of disillusionment?

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