External validity and anchoring heuristics: application of DUNDRUM-1 to secure service gatekeeping in South Wales

Lawrence, Daniel; Davies, T. A. L.; Bagshaw, Ruth; Hewlett, P. S.; Taylor, Pamela J.; Watt, Andrew

doi:10.1192/bjb.2017.6

Cited by 12 publications

(6 citation statements)

References 28 publications

(52 reference statements)

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“…The DUNDRUM-1 assessment [44,45,[52][53][54][55][56][57] was used to measure need for the appropriate level of therapeutic security. The DUNDRUM-1 is a static measure completed prior to admission.…”

Section: Need For Therapeutic Security Risk Of Violencementioning

confidence: 99%

A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: the DRILL tool (Dundrum restriction, intrusion and liberty ladders)

et al. 2020

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Background Prevention of violence due to severe mental disorders in psychiatric hospitals may require intrusive, restrictive and coercive therapeutic practices. Research concerning appropriate use of such interventions is limited by lack of a system for description and measurement. We set out to devise and validate a tool for clinicians and secure hospitals to assess necessity and proportionality between imminent violence and restrictive practices including de-escalation, seclusion, restraint, forced medication and others. Methods In this retrospective observational cohort study, 28 patients on a 12 bed male admissions unit in a secure psychiatric hospital were assessed daily for six months. Data on adverse incidents were collected from case notes, incident registers and legal registers. Using the functional assessment sequence of antecedents, behaviours and consequences (A, B, C) we devised and applied a multivariate framework of structured professional assessment tools, common adverse incidents and preventive clinical interventions to develop a tool to analyse clinical practice. We validated by testing assumptions regarding the use of restrictive and intrusive practices in the prevention of violence in hospital. We aimed to provide a system for measuring contextual and individual factors contributing to adverse events and to assess whether the measured seriousness of threating and violent behaviours is proportionate to the degree of restrictive interventions used. General Estimating Equations tested preliminary models of contexts, decisions and pathways to interventions. Results A system for measuring adverse behaviours and restrictive, intrusive interventions for prevention had good internal consistency. Interventions were proportionate to seriousness of harmful behaviours. A ‘Pareto’ group of patients (5/28) were responsible for the majority (80%) of adverse events, outcomes and interventions. The seriousness of the precipitating events correlated with the degree of restrictions utilised to safely manage or treat such behaviours. Conclusion Observational scales can be used for restrictive, intrusive or coercive practices in psychiatry even though these involve interrelated complex sequences of interactions. The DRILL tool has been validated to assess the necessity and demonstrate proportionality of restrictive practices. This tool will be of benefit to services when reviewing practices internally, for mandatory external reviewing bodies and for future clinical research paradigms.

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Section: Need For Therapeutic Security Risk Of Violencementioning

confidence: 99%

A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: the DRILL tool (Dundrum restriction, intrusion and liberty ladders)

et al. 2020

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“…Our study using the DUNDRUM‐1 suggests that it may improve judgement about security needs and thereby not only contribute to safety but also treatment engagement and completion. It will also ensure consistency and transparency of decision‐making within a governance structure and is likely to fill a gap in clarity of criteria for offender‐patient allocation to levels of therapeutic security not only in Belgium, where they have been lacking (Jeandarme et al., 2019b), but also in other jurisdictions (Lawrence et al., 2018). It is suggested that the DUNDRUM‐1 Triage Security might be used as part of the pre‐admission assessment when admission to a mental health service or community mental health team is under consideration, and when assessing anyone referred for admission or transfer to a therapeutically secure service, to supplement other assessment tools and particularly those focusing on risk of harm to others.…”

Section: Discussionmentioning

confidence: 99%

Is non‐completion of treatment related to security need?

Jeandarme

Habets

O’Reilly

et al. 2021

Criminal Behav Ment Health

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Background Treatment completion difficulties are common in forensic mental health settings and may have a profound impact on recidivism rates. Aims To test for associations between measures of risk and of security needs on the one hand and treatment non‐completion on the other among male offender‐patients in one medium security hospital. Methods We conducted a retrospective file study in a Flemish medium security hospital. A random sample of 25 treatment non‐completers was compared to a random same‐size sample of completers, each rated, blind to outcome, on the DUNDRUM‐1 security needs scale from data recorded at the time of admission to the unit. ‘Non‐completion’ was defined as any failure to complete treatment, whether staff‐terminated or self‐terminated; in Flanders, failure to comply with the judicial conditions of placement can result in re‐imprisonment. We used binary logistic regression to test relationships between treatment completion/non‐completion and security need, measured with the DUNDRUM‐1, together with a range of possible confounding variables. Results Most patients had psychosis and/or personality disorder and often substance use disorders also. Treatment non‐completion was invariably staff ordered because of security breaches. DUNDRUM‐1 and PCL‐R Facet 4 scores at the time of admission and HCR‐20 scores during admission were significantly higher among non‐completers than completers, but after binary logistic regression, only the DUNDRUM‐1 rating was independently associated with non‐completion. Conclusions Our study showed that an admission DUNDRUM‐1 rating, indicating levels of security need, co‐varies only to a small extent with the historical items of the HCR‐20, so may be regarded as measuring complementary domains. While conditions in Flanders at the time of the study complicated it in that medium security hospital units offered the highest level of hospital security available, the finding that non‐completion of treatment was particularly likely when the DUNDRUM‐1 indicated a higher security need than facilities could provide may have implications for all secure hospital services.

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“…9,[14][15][16][17] The DUNDRUM-1 triage security scale has been shown to have good internal consistency (Cronbach's alpha 0.95 in a Dundrum sample validation and 0.77 in an international validation study) and good interrater reliability. 9,10,[15][16][17][18][19] Interrater reliability is better following training. 17…”

Section: Needs Assessment Tool For Secure Carementioning

confidence: 99%

Security needs among patients referred for high secure care in Broadmoor Hospital England

et al. 2020

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Background Security needs among patients referred to forensic mental health services have rarely been systematically studied. Aims To ascertain security needs among patients referred to a high secure hospital, Broadmoor High Secure Hospital, England. We also aimed to compare the security needs for those referred to mental illness services with those referred to personality disorder services in the hospital. Method A retrospective complete cohort study of all referrals to Broadmoor Hospital over a 2-year period was conducted. All referred patients (n = 204) were assessed for need for high secure care by two Broadmoor clinicians. The final decision on need for admission was taken by a multidisciplinary admission panel. Independent of the panel, researchers rated need for security using the DUNDRUM-1 triage security scale. Results Those admitted to Broadmoor Hospital had higher triage security scores than those declined (F = 4.209, d.f. = 1, P = 0.042). Referrals to the personality disorder pathway had higher security needs than those referred to the mental illness pathway high secure service (F = 6.9835, d.f. = 1, P = 0.0089). Overall security needs among referrals to Broadmoor were extremely high, both by comparison with previous needs identified in UK medium secure services and international medium and high secure services. Conclusions High secure patient cohorts represent a uniquely vulnerable group within mental health services, with extremely high security needs identified in this study. This has significant implications for services given the high levels of resources needed to provide therapeutically safe and secure care and treatment to this group.

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External validity and anchoring heuristics: application of DUNDRUM-1 to secure service gatekeeping in South Wales

Cited by 12 publications

References 28 publications

A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: the DRILL tool (Dundrum restriction, intrusion and liberty ladders)

A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: the DRILL tool (Dundrum restriction, intrusion and liberty ladders)

Is non‐completion of treatment related to security need?

Security needs among patients referred for high secure care in Broadmoor Hospital England

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