Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-10T12:39:28.217Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of a risk assessment tool to predict violent behaviour by patients detained in a psychiatric intensive care unit

Published online by Cambridge University Press:  19 October 2011

Steve Brown  and
Martin Langrish
Steve Brown*
Affiliation:
Consultant Psychiatrist, Hampshire Partnership NHS Foundation Trust
Martin Langrish
Affiliation:
Ward manager, Hampshire Partnership NHS Foundation Trust
*
Correspondence to: Dr Steve Brown, Canon House, 6 Canon Street, Shirley, Southampton SO15 5PQ. Tel: 02380 878051. Email: steve.brown@hantspt-sw.nhs.uk
Get access

Abstract

Background: Structured assessment of risk is a standard element of the core psychiatric assessment, particularly in respect of individuals, who are perceived to be at risk of violence or suicide. Many acute mental health trusts have introduced risk assessment tools, often without evidence of validity.

Aim: To evaluate a tool designed to predict the acute risk of violence by patients detained in a PICU.

Method: A risk assessment form was completed weekly for each patient on the PICU. Multivariate logistic regression analysis was used to measure the predictive value of particular variables in respect of violent behaviour during the next two weeks.

Results: Violent behaviour during the previous two weeks was a significant predictor of subsequent violence. Drug use was a negative predictor. None of the other variables tested were predictive of violent behaviour.

Conclusions: A complicated risk assessment tool probably adds little to the process of predicting acutely violent behaviour in PICU patients. The introduction of procedures such as structured risk assessment tools should be subject to the same validation process as any other clinical initiative.

Keywords

Psychiatric unitintensive carerisk assessmentviolence
Type
Original Research Article
Information
Journal of Psychiatric Intensive Care , Volume 8 , Issue 1 , April 2012 , pp. 35 - 41
Copyright
Copyright © NAPICU 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abderhalden, C., Needham, I., Dassen, T., Halfens, R., Haug, H-J. and Fischer, J. (2008) Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial. The British Journal of Psychiatry. 193: 44–50.CrossRefGoogle ScholarPubMed
Brown, S., Chhina, N. and Dye, S. (2008) The psychiatric intensive care unit: a prospective survey of patient demographics and outcomes at seven English PICUs. Journal of Psychiatric Intensive Care. 4: 17–27.CrossRefGoogle Scholar
Buchanan, A. (2008) Risk of violence by psychiatric patients: beyond the “actuarial versus clinical” assessment debate. Psychiatric Services. 59: 184–190.CrossRefGoogle ScholarPubMed
Carroll, A. (2007) Are violence risk assessments clinically useful? Australia and New Zealand Journal of Psychiatry. 41: 301–307.CrossRefGoogle ScholarPubMed
Department of Health (2000) Effective Care-Coordination in Mental Health Services: Modernising Care Programme Approach. London: HMSO.Google Scholar
Department of Health (2002) Mental Health Policy Implementation Guide for National Minimum Standards for General Adult Services in Psychiatric Intensive Care Units (PICU) and Low Secure Environments. London: Department of Health.Google Scholar
Department of Health (2007) Best Practice in Managing Risk: Principles and Guidance for Best Practice in the Assessment and Management of Risk to Self and Others in Mental Health Services. London: HMSO.Google Scholar
Doyle, M. and Dolan, M. (2002) Violence risk assessment: combining actuarial and clinical information to structure clinical judgements for the formulation and management of risk. Journal of Psychiatric and Mental Health Nursing. 9: 649–657.CrossRefGoogle ScholarPubMed
Grevatt, M., Thomas-Peter, B. and Hughes, G. (2004) Violence mental disorder and risk assessment: can structured clinical assessments predict the short term risk of in-patient violence? Journal of Forensic Psychiatry and Psychology. 15: 278–292.CrossRefGoogle Scholar
Hare, R. (1991) The Hare Psychopathy Checklist – Revised. Toronto: Multi-Health Systems.Google Scholar
Hart, S., Michie, C. and Cooke, D. (2007) Precision of actuarial risk assessment instruments: evaluating the ‘margins of error’ of group v. individual predictions of violence. The British Journal of Psychiatry. 90: s60–s65.CrossRefGoogle Scholar
Higgins, N., Watts, D., Bindman, J., Slade, M. and Thornicroft, G. (2005) Assessing violence risk in general psychiatry. Psychiatric Bulletin. 29: 131–133.CrossRefGoogle Scholar
Monahan, J., Steadman, H., Robbins, P., Silver, E., Appelbaum, P., Grisso, T., Mulvey, E. and Roth, L. (2000) Developing a clinically useful actuarial tool for assessing violence risk. The British Journal of Psychiatry. 176: 312–319.CrossRefGoogle ScholarPubMed
Morgan, J.F. (2007) Giving up the Culture of Blame: Risk Assessment and Risk Management in Psychiatric Practice. London: Royal College of Psychiatrists.Google Scholar
Power, M. (2004) The Risk Management of Everything: Rethinking the Politics of Uncertainty. Demos. http://www.demos.co.uk/publications/riskmanagementofeverythingcatalogueGoogle Scholar
Qin, P., Agerbo, E. and Mortensen, P. (2003) Suicide risk in relation to socioeconomic, demographic, psychiatric, and familial factors: a national register-based study of all suicides in Denmark, 1981–1997. American Journal of Psychiatry. 160: 765–772.CrossRefGoogle ScholarPubMed
SPSS (2009) SPSS for Windows, version 17.0. Lead technologies, Inc.Google Scholar
Undrill, G. (2007) The risks of risk assessment. Advances in Psychiatric Treatment. 13: 291–297.CrossRefGoogle Scholar
Webster, C., Douglas, K., Eaves, D. and Hart, S. (1997) HCR-20. Assessing Risk for Violence, version 2. Vancouver: Mental Health Law and Policy Institute. Simon Fraser University.Google Scholar
Woods, P., Almvik, R. (2002) The Brøset violence checklist. Acta Psychiatrica Scandinavica. 106(supplement 412): 103–105.CrossRefGoogle Scholar