“…The method of data collection has previously been described [ 16 ]. In brief, a prospective cohort follow-up study was carried out on all forensic patients discharged from 32 National Health Service (NHS) medium secure units across England and Wales (in 26 NHS secondary care Trusts) between 1 st September 2010 and the 31 st August 2011.…”
BackgroundStructured Professional Judgement (SPJ) is routinely administered in mental health and criminal justice settings but cannot identify violence risk above moderate accuracy. There is no current evidence that violence can be prevented using SPJ. This may be explained by routine application of predictive instead of causal statistical models when standardising SPJ instruments.MethodsWe carried out a prospective cohort study of 409 male and female patients discharged from medium secure services in England and Wales to the community. Measures were taken at baseline (pre-discharge), 6 and 12 months post-discharge using the Historical, Clinical and Risk-20 items version 3 (HCR-20v3) and Structural Assessment of Protective Factors (SAPROF). Information on violence was obtained via the McArthur community violence instrument and the Police National Computer.ResultsIn a lagged model, HCR-20v3 and SAPROF items were poor predictors of violence. Eight items of the HCR-20v3 and 4 SAPROF items did not predict violent behaviour better than chance. In re-analyses considering temporal proximity of risk/ protective factors (exposure) on violence (outcome), risk was elevated due to violent ideation (OR 6.98, 95% CI 13.85–12.65, P<0.001), instability (OR 5.41, 95% CI 3.44–8.50, P<0.001), and poor coping/ stress (OR 8.35, 95% CI 4.21–16.57, P<0.001). All 3 risk factors were explanatory variables which drove the association with violent outcome. Self-control (OR 0.13, 95% CI 0.08–0.24, P<0.001) conveyed protective effects and explained the association of other protective factors with violence.ConclusionsUsing two standardised SPJ instruments, predictive (lagged) methods could not identify risk and protective factors which must be targeted in interventions for discharged patients with severe mental illness. Predictive methods should be abandoned if the aim is to progress from risk assessment to effective risk management and replaced by methods which identify factors causally associated with violence.
“…The method of data collection has previously been described [ 16 ]. In brief, a prospective cohort follow-up study was carried out on all forensic patients discharged from 32 National Health Service (NHS) medium secure units across England and Wales (in 26 NHS secondary care Trusts) between 1 st September 2010 and the 31 st August 2011.…”
BackgroundStructured Professional Judgement (SPJ) is routinely administered in mental health and criminal justice settings but cannot identify violence risk above moderate accuracy. There is no current evidence that violence can be prevented using SPJ. This may be explained by routine application of predictive instead of causal statistical models when standardising SPJ instruments.MethodsWe carried out a prospective cohort study of 409 male and female patients discharged from medium secure services in England and Wales to the community. Measures were taken at baseline (pre-discharge), 6 and 12 months post-discharge using the Historical, Clinical and Risk-20 items version 3 (HCR-20v3) and Structural Assessment of Protective Factors (SAPROF). Information on violence was obtained via the McArthur community violence instrument and the Police National Computer.ResultsIn a lagged model, HCR-20v3 and SAPROF items were poor predictors of violence. Eight items of the HCR-20v3 and 4 SAPROF items did not predict violent behaviour better than chance. In re-analyses considering temporal proximity of risk/ protective factors (exposure) on violence (outcome), risk was elevated due to violent ideation (OR 6.98, 95% CI 13.85–12.65, P<0.001), instability (OR 5.41, 95% CI 3.44–8.50, P<0.001), and poor coping/ stress (OR 8.35, 95% CI 4.21–16.57, P<0.001). All 3 risk factors were explanatory variables which drove the association with violent outcome. Self-control (OR 0.13, 95% CI 0.08–0.24, P<0.001) conveyed protective effects and explained the association of other protective factors with violence.ConclusionsUsing two standardised SPJ instruments, predictive (lagged) methods could not identify risk and protective factors which must be targeted in interventions for discharged patients with severe mental illness. Predictive methods should be abandoned if the aim is to progress from risk assessment to effective risk management and replaced by methods which identify factors causally associated with violence.
“…Author's reply: We are pleased to have received such commendations of our review on psychiatric ward design. 1 We believe, as the other commentators do, that this is a long-neglected area that needs more research to inform future investmentincluding the UK government's recently promised increase in in-patient wards for younger people. The physical environment of healthcare facilities does affect the patient experience and their satisfaction and is recognised as an integral part of care delivery.…”
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confidence: 88%
“…The psychiatric ward as a therapeutic space Papoulias et al 1 have added a great deal to our understanding of the research exploring the effects of ward design on both patients and staff. They highlight the breadth of study designs but also the varying quality of both patient and environmental measures.…”
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confidence: 99%
“…3 We also had an evidence-based, objective, before-and-after measure of the ward environment: the Environment Assessment Inventory (EAI). 4 This methodology, reviewing data before and after a ward change, enabled us to control for many of the important confounding factors that were highlighted by Papoulias et al, 1 as patient profiles, ward staffing and policies remained largely unchanged.…”
“…However, the number of sentenced prisoners remitted to prison more than doubled, from 96 to 229. A national study of discharges to prison from medium secure units in England and Wales in 2010–2011 found that nearly half of those discharged to prison were diagnosed with a serious mental illness and over a third with schizophrenia; these individuals were found to pose a higher risk, be more likely to have a personality disorder, have more severe symptoms and be significantly less likely to show motivation for treatment and positive attitudes towards authority than those discharged to the community (Doyle 2014). FIG 2 Transfers of mentally disordered prisoners to hospital for treatment under the Mental Health Act 1983 and remissions from hospital to prison after treatment (Ministry of Justice, personal communication, 2016).…”
Section: Development and Evaluation Of Diversion Initiativesmentioning
SummaryLiaison and diversion services are concerned with ensuring that individuals with mental health problems and related vulnerabilities who come into contact with the criminal justice system receive appropriate support and treatment. In the past 15 years there have been significant changes in policy, legislation and the broader landscape in community, custodial and hospital settings which have shaped these services. The Bradley Report, published in 2009, represents an important landmark in this field. Bradley made 82 recommendations, from interventions to improve identification of mental illness and vulnerable individuals at risk of offending to effecting speedier transfers of mentally disordered prisoners to hospital. Some progress has been made in achieving these recommendations, and further investment is promised, but at present only half of England is covered by liaison and diversion services.LEARNING OBJECTIVES•Appreciate how services have developed over the past 15 years to provide support and treatment and divert mentally disordered people from custody at all stages in the criminal justice process•Recognise how government policy has shaped the development of liaison and diversion services over the past 15 years•Understand the impact of the 2007 amendments to the Mental Health Act on the diversion of mentally disordered people from custody
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