Assessing violence risk in general adult psychiatry

Higgins, Nicola; Watts, David; Bindman, Jonathan; Slade, Mike; Thornicroft, Graham

doi:10.1192/pb.29.4.131

Cited by 53 publications

(51 citation statements)

References 12 publications

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“…Hitherto there has been just one English study examining this issue in detail (Higgins et al, 2005). Higgins et al asked consultants working in general adult psychiatry in 66 randomly selected mental healthcare providers to provide copies of their trust's RAP and to answer a series of questions about risk assessment documentation, training and guidance.…”

Section: Introductionmentioning

confidence: 99%

Structure and content of risk assessment proformas in mental healthcare

Hawley

Littlechild

Sivakumaran

et al. 2006

Journal of Mental Health

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Background: The NSF specifies that mental health service providers should have a locally agreed proforma for assessing risk. Risk assessment proformas (RAPs) currently in use vary considerably in both structure and content. This study describes some similarities and differences.Method: We requested a copy of each provider trust's RAP. These were assessed across a range of structural characteristics, including layout, design, data coding, and were also studied for their content.Results: Some consistency was seen in the themes addressed: suicide/self harm, risk to others (notably violence) and vulnerability were well represented. Several additional themes were notable by their absence. There was general conformity in the way in which data was coded, with most using tick box categories. However, there were striking differences in layout quality and usability and many common problems were identified.Conclusions: RAPs as currently used in NHS mental-health practice vary in structure, content, length and quality. We question (i) the most common approaches in recording risk data in RAPs, and (ii) whether the focus on three domains of risk acts to neglect other, less dramatic, areas. Risk assessment procedures need to be critically evaluated and the introduction of standardized tools would be advantageous in this respect.Declaration of interest: This work was supported by NHS R&D Support funding awarded to Hertfordshire Partnership NHS Trust.

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Section: Introductionmentioning

confidence: 99%

Structure and content of risk assessment proformas in mental healthcare

Hawley

Littlechild

Sivakumaran

et al. 2006

Journal of Mental Health

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“…A survey of randomly selected Mental Health Trusts in England confirmed uncertainty in practice about how to proceed. 134 The Violence Risk Appraisal Guide 135 is one tool used in specialist clinical practice, founded in data analysis from a Canadian cohort of high-security hospital patients. The HCR-20 136 is based on statistical analysis of the risk literature.…”

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confidence: 99%

Psychosis and Violence: Stories, Fears, and Reality

Taylor

2008

Can J Psychiatry

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Individuals with psychosis are often feared. In fact, they are themselves likely to be victims of violence; however, the main aim of this review is to provide an overview of the evidence on relations between psychosis and violence to others. The terms psychosis and violence were used in a literature search limited to the Cochrane Library and PubMed, a manual search of 8 journals, and a follow-up of additional references in the articles found. The overview draws on new empirical data and major reviews. Almost all sound epidemiologic data on psychosis and violence dates from 1990. There is consistency on a small but significant relation between schizophrenia and violent acts. Since then there has also been movement toward understanding the nature of associations and progress on strategies for managing individuals who have psychosis and are violent. Public fears about individuals with psychotic illnesses are largely unfounded, although there would be benefit in greater attention to the safety of those in their close social circle. The task for the next 10 years must be the development and application of knowledge to improve specific treatments—that is, interventions that go beyond holding and caring to bring about substantial change.

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“…There is inter-trust variability in the use of risk assessment forms, and even where mandatory for in-patients the completion rate can be as low as 61% (Higgins et al, 2005;Stein, 2005). To date, there is lack of an adequate evidence base focusing on factors that could influence the completion of generic risk assessment forms.…”

Section: Discussionmentioning

confidence: 99%

“…The increasing expectation on all mental health professionals to identify, appraise and manage risk has led to the introduction of generic risk forms at trust level. Although 67% of trusts have standardised forms for risk assessment, the lack of a gold standard has resulted in striking variation with regards to content, complexity and evidence base (Higgins et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Risk assessment of psychiatric in-patients: audit of completion of a risk assessment tool

Masson

Liew

Taylor³

et al. 2008

Psychiatr. bull.

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Aims and MethodTwo complete audit cycles were used to assess the completion of a bespoke risk assessment tool and whether an educational intervention, and subsequently the introduction of a standardised admission pack, led to improvements in completion rates.ResultsThe total rate of completion of forms improved from 60% to 81% following a brief educational intervention in the form of a lecture and email about the audit. The subsequent introduction of a standardised admission pack containing the tool maintained completion rates.Clinical ImplicationsAudit coupled with a simple educational intervention can improve the completion of risk assessment forms by medical and nursing staff.

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Assessing violence risk in general adult psychiatry

Cited by 53 publications

References 12 publications

Structure and content of risk assessment proformas in mental healthcare

Structure and content of risk assessment proformas in mental healthcare

Psychosis and Violence: Stories, Fears, and Reality

Risk assessment of psychiatric in-patients: audit of completion of a risk assessment tool

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