Aggression and seclusion on acute psychiatric wards: effect of short-term risk assessment

Sande, R.R.W. van de; Nijman, Henk; Noorthoorn, Eric; Wierdsma, André I.; Hellendoorn, Edwin; Staak, C.P.F. van der; Mulder, C.L.

doi:10.1192/bjp.bp.111.095141

Cited by 124 publications

(106 citation statements)

References 26 publications

(31 reference statements)

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“…Increasing the use of structured short-term risk assessment tools to evaluate risks associated with aggression and seclusion has been successful in reducing patient hours in seclusion (van de Sande et al, 2011), and may be particularly relevant for tailoring strategies to high-risk cases. Our research suggests that such tools should include information about previous seclusion/restraint episodes and hours in containment.…”

Section: Discussionmentioning

confidence: 99%

Seclusion and restraint use in adult inpatient mental health care: An Australian perspective

Oster

Gerace

Thomson³

et al. 2016

Collegian

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Section: Discussionmentioning

confidence: 99%

Seclusion and restraint use in adult inpatient mental health care: An Australian perspective

Oster

Gerace

Thomson³

et al. 2016

Collegian

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“…An exception is the use of daily risk assessment instruments by nurses. Two cluster randomized studies showed that risk assessment reduced the number of aggressive incidents (49, 50) as well as the duration of seclusion (50). Only few hospitals, however, use these methods.…”

Section: Training/preventionmentioning

confidence: 99%

The Use of Coercive Interventions in Mental Health Care in Germany and the Netherlands. A Comparison of the Developments in Two Neighboring Countries

Steinert

Noorthoorn

Mulder

2014

Front. Public Health

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In this review, we compare the use of coercion in mental health care in Germany and in the Netherlands. Legal frameworks and published data on involuntary commitment, involuntary medication, seclusion, and restraint are highlighted as well as the role of guidelines, training, and attitudes held by psychiatrists and the public. Legal procedures regulating involuntary admission and commitment are rather similar, and so is the percentage of involuntary admissions and the rate per 100,000 inhabitants. However, opposing trends can be observed in the use of coercive interventions during treatment, which in both countries are considered as a last resort after all other alternative approaches have failed. In the Netherlands, for a long time seclusion has been considered as preferred intervention while the use of medication by force was widely disapproved as being unnecessarily invasive. However, after increasing evidence showed that number and duration of seclusions as well as the number of aggressive incidents per admission were considerably higher than in other European countries, attitudes changed within recent years. A national program with spending of 15 million € was launched to reduce the use of seclusion, while the use of medication was facilitated. A legislation is scheduled, which will allow also outpatient coercive treatment. In Germany, the latter was never legalized. While coercive treatment in Germany was rather common for involuntarily committed patients and mechanical restraint was preferred to seclusion in most hospital as a containment measure, the decisions of the Constitutional Court in 2011 had a high impact on legislation, attitudes, and clinical practice. Though since 2013 coercive medication is approvable again under strict conditions, it is now widely perceived as very invasive and last resort. There is evidence that this change of attitudes lead to a considerable increase of the use of seclusion and restraint for some patients.

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“…Information needed to rate the HCR-20-C is routinely collected in the course of admitting patients to a psychiatric inpatient unit, and prompting trainees to rate this structured measure could aid them in attending to valid risk markers from among the vast amount of information that may become available during the course of an admission workup. Third, the improvements in accuracy offered by use of a structured risk assessment tool have the potential to guide development of interventions to prevent violence (40). …”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Level of Training and Accuracy of Violence Risk Assessment

Teo¹,

Holley²,

Leary³

et al. 2012

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Objective Although clinical training programs aspire to develop competency in violence risk assessment, little research has examined whether level of training is associated with the accuracy of clinicians’ evaluations of violence potential. This is the first study to compare the accuracy of risk assessments by experienced psychiatrists to those of psychiatric residents. It also examined the potential of a structured decision support tool to improve residents’ violence risk assessments. Methods Using a retrospective case control design, medical records were reviewed for 151 patients who assaulted staff at a county hospital and 150 comparison patients. At admission, violence risk assessments had been completed by psychiatric residents (N= 38) for 52 patients, and by attending psychiatrists (N = 41) for 249 patients. Trained, blinded research clinicians coded information available at hospital admission with a structured risk assessment tool, the HCR-20 Clinical (HCR-20-C) scale. Results Receiver operating characteristic analyses showed that clinical estimates of violence risk by attending psychiatrists had significantly higher predictive validity than those of psychiatric residents. Risk assessments by attending psychiatrists were moderately accurate (AUC = .70), whereas risk assessments by residents were no better than chance (AUC = .52). Incremental validity analyses showed that addition of information from the HCR-20-C had the potential to improve the accuracy of risk assessments by residents to a level (AUC = .67) close to that of attending psychiatrists. Conclusions Less training and experience is associated with inaccurate violence risk assessment. Structured methods hold promise for improving training in risk assessment for violence.

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Aggression and seclusion on acute psychiatric wards: effect of short-term risk assessment

Abstract: Routine application of structured risk assessment measures might help reduce incidents of aggression and use of restraint and seclusion in psychiatric wards.

Cited by 124 publications

References 26 publications

Seclusion and restraint use in adult inpatient mental health care: An Australian perspective

Seclusion and restraint use in adult inpatient mental health care: An Australian perspective

The Use of Coercive Interventions in Mental Health Care in Germany and the Netherlands. A Comparison of the Developments in Two Neighboring Countries

The Relationship Between Level of Training and Accuracy of Violence Risk Assessment

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