Assessing the risk of imminent aggression in mentally ill young offenders

Abstract

It is possible to monitor the risk state of hospitalised mentally ill youth, so that heightened states can be detected early, thus facilitating interventions to reduce the risk of violence.

The DASA:YV assists the appraisal of imminent aggression risk in young patients

“…Large suggests that risk assessment, as described in our study, 1 distracts staff from patient care, due to an excessive opportunity cost. This is incorrect.…”

“…He is mistaken in his belief that it is not worth attempting to elucidate precursors for imminent aggression in young offenders with a mental illness. 1 There is evidence that short-term risk assessment can reduce aggression and reliance on coercive measures. Several European studies have tested the impact of risk assessments on the use of restrictive practices and aggressive behavior.…”

“…Using the sensitivity (65.9%) and specificity (83.1%) from our study, 1 Large calculated the positive predictive value of the DASA:YV (the proportion of DASA:YV positive cases that became violent) to be 16%. He claimed the instrument had a “95% chance of being wrong”, which is simply incorrect (100% – 16% = 84%), and it is misleading to focus only on false positives.…”

Using the Dynamic Appraisal of Situational Aggression with mental health inpatients: a feasibility study

“… 16 A final risk judgment (low, medium, high) is formed based on a review of the items and the total score as well as knowledge of the patient’s usual behavior and history of violence. 16 The DASA has been validated in various clinical settings, 26 , 34 , 35 both in Asia 36 and in Western countries. 30 , 33 It has repeatedly exhibited good-to-excellent predictive accuracy for aggression, 25 , 26 , 36 with good internal consistency and interrater reliability.…”

Validating a Measurement Tool to Predict Aggressive Behavior in Hospitalized Youth

“…Outside Stressors was added because acute stress is thought to increase aggressive behavior, especially if unable to resolve during hospitalization (Daffern & Ogloff, 2014). The youth version was tested and predicted imminent aggression (AUC = 0.754) in a prospective validation study with mentally ill adolescent male offenders in a forensic hospital setting and demonstrated improvement of predictive accuracy compared with the adult version DASA (Kasinathan et al, 2015). At the time of this study, the youth version (DASA-YV) of the adult DASA tool had yet to be validated in the youth inpatient psychiatric population.…”