Application of Risk Assessment for Violence Methods to General Adult Psychiatry: A Selective Literature Review

Abstract

In order to develop a system of risk assessment relevant to general adult psychiatry, we note the benefits of shifting from risk prediction to assessment, management and reduction of risk, the need to merge actuarial and clinical approaches, communication of risk and finally the need to involve patients in the process of risk assessment.

Survey of mental health nurses' attitudes towards risk assessment, risk assessment tools and positive risk

“…Actuarial methods involves the use of validated instruments or tools (Godin , Kettles & Woods ). Structured clinical judgement, uses a combination of the previous two approaches, and involves the practitioner using a combination of clinical knowledge, research evidence and risk assessment tools (Doyle & Dolan , Kumar & Simpson ). While the structured clinical judgement approach is the preferred method, the value of risk assessment tools is hotly debated within the literature (Crowe & Carlyle , Webb , Boland & Bremner ).…”

“…Critics of the method comment on the little empirical evidence available to support the ability of tools to predict accurately (Crowe & Carlyle , Feeney , Royal College of Psychiatrists , Wand , Boland & Bremner , McCallum & Eagle ). Many argue that tools are based on information about groups, which is of limited value in predicting the behaviours of an individual (Kumar & Simpson , Woods & Kettles , Wand ). In addition, critics argue that tools tend to focus on historical (static) risk factors thus ignoring the dynamic or situational variables, which impact on the person (Doyle & Dolan ).…”

Screening for risk of violence using service users’ self‐perceptions: A prospective study from an acute mental health unit

“…Involving service users in their own violence risk assessments is a means of helping service users to understand why interventions are necessary (Kumar & Simpson 2005). Successful inclusion in the therapeutic SRS-d = Self-report Risk Scale; 'Age' and 'Neurotic stress-related and somatoform disorders' were tested with nonsignificant results.…”

“…process may contribute to empowerment, which can also have a positive impact on the development of therapeutic relationships (Hamann et al 2003). Being open and nonjudgemental about these issues is likely to help establish a relationship based on partnership between service users and practitioners (Kumar & Simpson 2005), and positive therapeutic relationships are helpful for preventing violence (Gilburt et al 2008). Being open and nonjudgemental about these issues is likely to help establish a relationship based on partnership between service users and practitioners (Kumar & Simpson 2005), and positive therapeutic relationships are helpful for preventing violence (Gilburt et al 2008).…”

The Need for the Development and Evaluation of Preventive Psychosocial Forensic Interventions in Mainstream Adult Community Mental Health Services

“…3 In the absence of a coherent, evidence-based and adequately resourced model of intervention, community mental health staff may experience fear, low morale and danger in the workplace. 25 Notwithstanding these limitations, it is unfortunate that many mental health clinicians have not received evidence-based training in these tools or in forensic risk assessment or had the clinical experience of forensic clinicians. A recent multi-site study across four countries matched a group of patients diagnosed with schizophrenia who were treated through forensic services with a group treated through general psychiatric hospitals.…”