Risk assessment of imminent violence in acute psychiatry: a step towards an extended model

Lockertsen, Øyvind; Varvin, Sverre; Færden, Ann; Eriksen, Bjørn Magne Sundsbø; Roaldset, John Olav; Procter, Nicholas; Vatnar, Solveig Karin Bø

doi:10.1080/14789949.2019.1663898

Cited by 7 publications

(5 citation statements)

References 57 publications

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“…Consequently, it would be relevant to develop a patient version of START to support and increase the involvement of the mentally disordered offenders, thereby supporting the processes of personal recovery. Lockertsen et al ( 47 ) added items to the original version of the BVC and studied their extended version; for example, their Self-Report Risk Scale provided patients with an opportunity to predict their risk of violence. As a result, their study showed that expressing one's risk resulted in better short-term accuracy of predicting violence than the original BVC ( 45 ).…”

Section: Discussionmentioning

confidence: 99%

Effects of Implementing the Short-Term Assessment of Risk and Treatability for Mechanical Restraint in a Forensic Male Population: A Stepped-Wedge, Cluster-Randomized Design

et al. 2022

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The assessment and formulation of the risk of violence and other unwanted behaviors at forensic psychiatric facilities have been attempted for decades. Structured professional judgment tools, such as the Short-Term Assessment of Risk and Treatability (START), are among the recent attempts to overcome the challenge of accomplishing these goals. This study examined the effect of implementing START in clinical practice for the most serious adverse events among the target group of severely mentally ill forensic psychiatric inpatients. Results were based on the use of mechanical restraints as an outcome. This study is a pragmatic, stepped-wedge, cluster-randomized controlled trial and was conducted over 5 years. It included eight forensic psychiatric units. Fifty out of 156 patients who had a basic aggression score of more than 0 were included in the study. We found that the rate of mechanical restraint use within the START period were 82% [relative risk (RR) = 0.18], lower than those outside of the START period. Patients evaluated within the START period were also found to have a 36% (RR = 0.64) lower risk of having higher Brøset Violence Checklist scores than patients evaluated outside the START period. Previous studies on START have primarily focused on validation, the predictive capability of the assessment, and implementation. We were only able to identify one study that aimed to identify the benefits and outcomes of START in a forensic setting. This study showed a significant reduction in the chance for inpatients in a forensic psychiatric facility to become mechanically restrained during periods where the START was used as risk assessment.

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Section: Discussionmentioning

confidence: 99%

Effects of Implementing the Short-Term Assessment of Risk and Treatability for Mechanical Restraint in a Forensic Male Population: A Stepped-Wedge, Cluster-Randomized Design

et al. 2022

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“…No specific qualification or training is required ( 15 ). Though a total score is typically divided into three risk categories (small, moderate, high risk), each reflecting a higher risk of violent behavior, different cut-off scores are reported [≥ 4 ( 20 ) and ≥ 3 for high risk ( 15 )]. Longitudinal and randomized-control trials suggest sufficient reliability and validity for short-term violent behavior ( 15 , 23 , 24 ).…”

Section: Methodsmentioning

confidence: 99%

“…Effect sizes with a value of .56, .64, .71 represent a small, medium and large effect size, respectively ( 31 ). To compare cut-off points of previous studies of the BVC ( 15 , 20 ) and V-RISK-10 ( 17 , 18 , 27 ) for violent behavior, we calculated optimal cut-off scores based on the Youden’s index ( 32 ). The Youden’s index is determined by maximizing the difference between the true positive and false positive rate.…”

Section: Methodsmentioning

confidence: 99%

“…Secondly, Anderson and Jenson (2019) recommended to investigate the incremental validity when used in conjunction with BVC ( 7 ). Nonetheless, a recent study examined the incremental validity solely using one item of the V-RISK-10 ( 20 ). In terms of generalizing the instrument towards specific subpopulations, an adapted version for young people exists ( 21 ).…”

Section: Introductionmentioning

confidence: 99%

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The predictive validity of the V-RISK-10 and BVC among involuntarily admitted patients

Kös,

Bräunig,

Hausam

2024

Front. Psychiatry

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Although endangerment towards others is a criterion for an involuntary admission in many countries, research on risk assessment of endangerment among involuntarily admitted individuals is limited. In this retrospective case-control study, we calculated scores for a German-translated version of the Violence Risk Screening-10 (V-RISK-10) and the Brøset Violence Checklist (BVC) in a sample of 111 people undergoing an involuntary admission in Reinickendorf, Berlin. Outcomes were violence, coercive measures, and readmission. In line with our hypotheses, the BVC demonstrated stronger predictive validities for short-term, and V-RISK-10 for long-term events. There was an incremental validity for both instruments for restraint 24 hours after admission and any violence until discharge. These findings support the evidence that structured risk assessment instruments may be useful for individuals undergoing an involuntary admission. Ethical considerations about screening procedures are discussed.

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“…An improved understanding of violence and aggression is therefore key to developing preventative measures to alleviate distress caused (McIvor et al, 2022). There is variation in the reported proportion of inpatients enacting violence and aggression on acute psychiatric wards, with study estimates ranging between 17-40% (Iozzino et al, 2015;Lockertsen et al, 2020). In the United Kingdom (UK) specifically, predictions lie on the upper bound of this estimate (Renwick et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Consistency of Violence: Implications for Effective Inpatient Psychiatric Care

McIvor

Payne-Gill

Winter

et al. 2023

Adm Policy Ment Health

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Instances of violence and aggression in acute psychiatric settings are common and highly distressing for service users and staff. They also incur financial costs. This study aimed to identify the proportion of service users at risk of consistent violence/aggression enactment. It also aimed to analyse associated service use to explore the potential need for specialised, targeted approaches. Five years’ worth of data were extracted from 2016 to 2020 on inpatient stays across South London and Maudsley NHS Foundation Trust (SLaM) acute adult wards and Psychiatric Intensive Care Units (PICUs). Service users were divided into cohorts based on relative number of violent/agressive incidents enacted. Differences in frequency of acute service use during the period 1st January-31st December 2020 were analysed. In total, 2524 service users had at least one inpatient stay during 2020. 679 were recorded as having enacted at least one incident of violence or aggression. Just 4% of all service users accounted for 50% of all violence/aggression enactment. Results further showed strong evidence of group differences between violence cohorts in the following domains: internal transfers, occupied bed days, admissions and Place of Safety (PoS) referrals. There was weaker evidence for group differences in referrals to Home Treatment teams (HTTs) and Psychiatric Liaison Teams. A small proportion of service users disproportionately account for the majority of violent and aggressive incidents and higher levels of violence and aggression are associated with more acute service use. The provision of targeted, personalised interventions for this cohort may reduce the enactment of violence and aggression, leading to improved quality life and a reduction in financial expenditure.

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Risk assessment of imminent violence in acute psychiatry: a step towards an extended model

Cited by 7 publications

References 57 publications

Effects of Implementing the Short-Term Assessment of Risk and Treatability for Mechanical Restraint in a Forensic Male Population: A Stepped-Wedge, Cluster-Randomized Design

Effects of Implementing the Short-Term Assessment of Risk and Treatability for Mechanical Restraint in a Forensic Male Population: A Stepped-Wedge, Cluster-Randomized Design

The predictive validity of the V-RISK-10 and BVC among involuntarily admitted patients

Consistency of Violence: Implications for Effective Inpatient Psychiatric Care

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