Managing aggression and violence: The clinician’s role in contemporary mental health care

Allnutt, Stephen; Ogloff, James R. P.; Adams, Jonathon; O'Driscoll, Colmán; Daffern, Michael; Carroll, Andrew; Nanayakkara, Vindya; Chaplow, David

doi:10.1177/0004867413484368

Cited by 19 publications

(18 citation statements)

References 63 publications

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“…monitoring interventions) and tertiary prevention (e.g. acute coercion interventions) strategies were all noted in the data and support the assumption that reducing risk within a forensic inpatient setting needs to consider a wide range of perspectives and strategies (Allnutt et al, 2013).…”

Section: Clinical Use Of Structured Risk Assessment Instruments By Fisupporting

confidence: 73%

“…Violence prevention within forensic and inpatient psychiatric settings can include addressing all three types of these violence prevention perspectives, even though the extent to which this is done and the effectiveness of such strategies have not been investigated (Hallet et al, 2014). A wide range of risk management interventions usually need to be considered (Allnutt et al, 2013). Douglas et al (2013) and Doyle and Logan (2012) suggest the following main types of risk management interventions: monitoring, supervision, treatment and victim safety planning.…”

Section: Risk Managementmentioning

confidence: 99%

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The challenges of using structured risk assessment instruments in forensic psychiatric care

Levin

2019

Linköping University Medical Dissertations

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Background: The purpose of psychiatric forensic care is to provide treatment for mentally ill offenders and to prevent future acts of violence and other adverse events. During care, the type of restrictions of freedom, the patient's continuous need for involuntary treatment and readiness for discharge, are continuously evaluated based on the assessment of risk the patient pose to themselves and others as well as the progress achieved with treatment. The use of structured risk assessment instruments is recommended in clinical guidelines to assess such risks. However, unstructured clinical assessments, considered to be less valid, are often used in clinical practice. There is insufficient research evidence concerning several aspects related to the clinical use of structured risk assessment instruments in terms of guiding the planning and realization of care and risk management interventions. There is also a lack of knowledge about what patients themselves perceive to be mediating factors for their use of violence. The challenges of using structured risk assessment instruments 8 al care givers. Patients are often actively striving and struggling to understand and manage their own risk of acting out in violence. Real-life experiences in forensic psychiatric care sparked my interest in trying to understand more about the barriers and facilitators of the clinical use of structured risk assessments to prevent violence and other adverse events as well as the patient perspectives on factors that contribute to or inhibit violence. This PhD thesis is the product of this endeavour. NICE, 2007; Risk Management Authority, 2006). SRAIs have been developed for and implemented and used in forensic mental health services, secure psychiatric in-care services and correctional services to assess the risk of adverse events. Much of the research of risk assessment instruments comes from these different types of services.

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Section: Clinical Use Of Structured Risk Assessment Instruments By Fisupporting

confidence: 73%

Section: Risk Managementmentioning

confidence: 99%

The challenges of using structured risk assessment instruments in forensic psychiatric care

Levin

2019

Linköping University Medical Dissertations

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“…Insufficient training, a lack of organizational support, costs as well as a lack of multidisciplinary collaboration have been mentioned as hindrances to their implementation [20–22]. Further, research about the utility of structured violence risk assessments at the grassroots is still limited, awakening an ongoing debate around the usefulness and purposefulness of these tools in everyday nursing [20].…”

Section: Introductionmentioning

confidence: 99%

Interventions following a high violence risk assessment score: a naturalistic study on a Finnish psychiatric admission ward

Kaunomäki

Jokela

Kontio

et al. 2017

BMC Health Serv Res

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BackgroundPatient aggression and violence against staff members and other patients are common concerns in psychiatric units. Many structured clinical risk assessment tools have recently been developed. Despite their superiority to unaided clinical judgments, staff has shown ambivalent views towards them. A constant worry of staff is that the results of risk assessments would not be used. The aims of the present study were to investigate what were the interventions applied by the staff of a psychiatric admission ward after a high risk patient had been identified, how frequently these interventions were used and how effective they were.MethodsThe data were collected in a naturalistic setting during a 6-month period in a Finnish psychiatric admission ward with a total of 331 patients with a mean age of 42.9 years (SD 17.39) suffering mostly from mood, schizophrenia-related and substance use disorders. The total number of treatment days was 2399. The staff assessed the patients daily with the Dynamic Appraisal of Situational Aggression (DASA), which is a structured violence risk assessment considering the upcoming 24 h. The interventions in order to reduce the risk of violence following a high DASA total score (≥4) were collected from the patients’ medical files. Inductive content analysis was used.ResultsThere were a total of 64 patients with 217 observations of high DASA total score. In 91.2% of cases, at least one intervention aiming to reduce the violence risk was used. Pro re nata (PRN)-medication, seclusion and focused discussions with a nurse were the most frequently used interventions. Non-coercive and non-pharmacological interventions like daily activities associated significantly with the decrease of perceived risk of violence.ConclusionIn most cases, a high score in violence risk assessment led to interventions aiming to reduce the risk. Unfortunately, the most frequently used methods were psychopharmacological or coercive. It is hoped that the findings will encourage the staff to use their imagination when choosing violence risk reducing intervention techniques.

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“…It is currently accepted that we should not rely on clinical impressions to evaluate the risk of violence in MDOs [26]. In particular, adoption of such methods may lead to an over estimation of risk, resulting in an increase in unnecessary detentions [6].…”

Section: Development Of Risk Assessment Strategiesmentioning

confidence: 99%

Risk Assessment and Manage- ment of Violence in Patients with Mental Disorders: A Re- view

Shiina¹

2015

FLIS

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Managing aggression and violence: The clinician’s role in contemporary mental health care

Cited by 19 publications

References 63 publications

The challenges of using structured risk assessment instruments in forensic psychiatric care

The challenges of using structured risk assessment instruments in forensic psychiatric care

Interventions following a high violence risk assessment score: a naturalistic study on a Finnish psychiatric admission ward

Risk Assessment and Manage- ment of Violence in Patients with Mental Disorders: A Re- view

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