Therapeutic Risk Management for Violence: Safety Planning for Other-directed Violence

Abstract

Therapeutic management of risk for other-directed violence (ODV) involves screening, assessment, and clinically appropriate intervention. In this 5-part series, effective screening and assessment for ODV have been described as a combination of clinical interviewing and the use of structured tools to inform clinical impressions of both acute and chronic risk for violence. Once risk of violence is identified, therapeutic management of the risk throughout the course of treatment is best achieved by determining the function of the violent ideation and behavior. This can be achieved through the use of functional chain analysis. Chain analysis not only serves the purpose of providing insight into the contingencies of violent behavior but also helps to identify target areas of intervention where other skills, strategies, and means to access resources for support can be applied. In this fifth and final column of the series, we describe an intervention with all of these outcomes as its goals. A safety plan for ODV assists both clients and mental health professionals in disrupting patterns of violent ideation or behavior that would otherwise continue causing not only harm to others but prolonged negative consequences for those engaging in such behaviors.

Crisis plans in mental health: A scoping review

“…According to some authors, the completion of a crisis plan should be initiated at the admission of the service user, since it represents a great opportunity to initiate the therapeutic alliance (Billé, 2022;Jankovic et al, 2010). The most frequent moment in the literature is after the crisis since the proximity in time to the crisis allows the service user to reflect on the events (Brovelli et al, 2017;Farrelly et al, 2015;Ferrari et al, 2018;McGarity et al, 2021;Michaud et al, 2021;National Alliance on Mental Illness, 2016;Spangler, 2019;Stanley & Brown, 2012). Several authors add, however, that being too close in time to the crisis could lead to anxiety and emotional damage (Michaud et al, 2021;Spangler, 2019).…”

“…Several authors emphasize organizing a meeting prior to the completion of a crisis plan (Barrett et al, 2013;Borschmann et al, 2013Borschmann et al, , 2014Drolet-Dostaler, 2016;Farrelly, 2013;Farrelly et al, 2016;Farrelly, Szmukler, et al, 2014;Ferrari et al, 2018;Flood et al, 2006;Henderson et al, 2008Henderson et al, , 2017Maître, 2018;Maître et al, 2013;McGarity et al, 2021;Ruchlewska, Mulder, et al, 2014;Ruchlewska, Wierdsma, et al, 2014;State of Victoria, 2015;Thornicroft et al, 2013). During this meeting, it is expected that the plan and its content will be presented to the service user, allowing them to reflect on the elements to be addressed during the writing process.…”

“…They, therefore, share very similar aims and content. Recent studies have also shown the implementation of different crisis plans with service users with mental health disorders that differ from their initial intention thus highlighting their applicability and potential transferability to other crisis contexts (McGarity et al, 2021; Michaud et al, 2021). However, to our knowledge, no studies have examined these different models of plans, thus resulting in a lack of consensus regarding their aim and modalities.…”

Firearm Injury Prevention and Extreme Risk Protection Orders

“…Whether designed to reduce risk for violence against oneself or others, risk mitigation strategies necessitate efforts to make the environment safe. 1,2 Given the lethality and prevalence of firearm injuries nationally, prevention of firearm injury features prominently in interventions addressing both suicide and other-directed violence. For this reason, a relatively recent column specifically addressed firearm-related lethal means safety.…”

Practical Steps Towards Identifying and Assisting Victims of Domestic Violence

“…To close out our series addressing therapeutic risk management for violence, [1][2][3][4][5] it seems appropriate to present a guest column reflecting on the needs of victims of violence. To this end, guest columnists Chien and colleagues offer an excellent overview on the subject of domestic violence, with concrete guidance about screening, risk assessment, and safety planning for domestic violence.…”