Risk assessment is inseparable from risk management

Kennedy, Harry G

doi:10.1192/pb.25.6.208

Cited by 16 publications

(12 citation statements)

References 17 publications

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“…Scales and items with significant AUC statistics may have better than random sensitivity and specificity, but may still be weak predictors. While this reflects the reality of multiple co-linearity, any argument that a risk assessment scale made up of just a few of the strongest items would be sufficient is at odds with the clinical need to take notice of a much wider range of risk and protective factors when planning care and treatment [7,8] and when making recommendations or decisions regarding discharge [25]. However it is also the case that using structured professional judgement instruments to assess treatment needs would be invalid if many of the items were poor predictors on their own.…”

Section: Discussionmentioning

confidence: 99%

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Susceptibility (risk and protective) factors for in-patient violence and self-harm: prospective study of structured professional judgement instruments START and SAPROF, DUNDRUM-3 and DUNDRUM-4 in forensic mental health services

et al. 2013

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BackgroundThe START and SAPROF are newly developed fourth generation structured professional judgement instruments assessing strengths and protective factors. The DUNDRUM-3 and DUNDRUM-4 also measure positive factors, programme completion and recovery in forensic settings.MethodsWe compared these instruments with other validated risk instruments (HCR-20, S-RAMM), a measure of psychopathology (PANSS) and global function (GAF). We prospectively tested whether any of these instruments predict violence or self harm in a secure hospital setting (n = 98) and whether they had true protective effects, interacting with and off-setting risk measures.ResultsSAPROF and START-strengths had strong inverse (negative) correlations with the HCR-20 and S-RAMM. SAPROF correlated strongly with GAF (r = 0.745). In the prospective in-patient study, SAPROF predicted absence of violence, AUC = 0.847 and absence of self-harm AUC = 0.766. START-strengths predicted absence of violence AUC = 0.776, but did not predict absence of self-harm AUC = 0.644. The DUNDRUM-3 programme completion and DUNDRUM-4 recovery scales also predicted in-patient violence (AUC 0.832 and 0.728 respectively), and both predicted in-patient self-harm (AUC 0.750 and 0.713 respectively). When adjusted for the HCR-20 total score however, SAPROF, START-S, DUNDRUM-3 and DUNDRUM-4 scores were not significantly different for those who were violent or for those who self harmed. The SAPROF had a significant interactive effect with the HCR-dynamic score. Item to outcome studies often showed a range of strengths of association with outcomes, which may be specific to the in-patient setting and patient group studied.ConclusionsThe START and SAPROF, DUNDRUM-3 and DUNDRUM-4 can be used to assess both reduced and increased risk of violence and self-harm in mentally ill in-patients in a secure setting. They were not consistently better than the GAF, HCR-20, S-RAMM, or PANSS when predicting adverse events. Only the SAPROF had an interactive effect with the HCR-20 risk assessment indicating a true protective effect but as structured professional judgement instruments all have additional content (items) complementary to existing risk assessments, useful for planning treatment and risk management.

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Section: Discussionmentioning

confidence: 99%

“…Identifying risk factors is held to be an aid to treatment planning [7] and perhaps for this reason risk assessment has come to pervade forensic mental health practice.…”

Section: Introductionmentioning

confidence: 99%

Susceptibility (risk and protective) factors for in-patient violence and self-harm: prospective study of structured professional judgement instruments START and SAPROF, DUNDRUM-3 and DUNDRUM-4 in forensic mental health services

et al. 2013

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“…Violence should, therefore, be easier to predict than homicide or suicide, with extra services being targeted at about 11% of patients with severe mental illness (Kennedy, 2001).…”

Section: Risk Assessment In a Stratified Systemsmentioning

confidence: 99%

Therapeutic uses of security: mapping forensic mental health services by stratifying risk

Kennedy¹

2002

Adv. psychiatr. treat

154

146

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The syllabus for higher training in forensic psychiatry requires knowledge of the therapeutic uses of security, although there are no references to this in standard texts. Similarly, the process of mapping a mental health service is an essential first step in planning, audit and needs assessment. All mental health services, not just forensic services, are organised to stratify patients according to the risk they present so that they can be cared for in an environment that is safe but imposes the minimum necessary restrictions and intrusions. Forensic mental health services differ from other mental health services mainly by including subsystems which are at higher levels of security than those necessary in local services. Although they have a general orientation towards risk awareness and risk management, they remain integral parts of the mental health services for the populations they serve.

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“…Proponents of risk assessment argue that it simply requires basic clinical skills (Snowden, 1997), that the process itself can be valuable (Holloway, 1998), and that it is inseparable from risk management (Kennedy, 2001). Research has identified relevant dispositional, historical and situational risk factors for violence (Monahan & Steadman, 1994), and it has been suggested that actuarial methods might enhance predictive accuracy (Dolan & Doyle, 2000).…”

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confidence: 99%

Assessing violence risk in general adult psychiatry

Higgins

Watts²,

Bindman³

et al. 2005

Psychiatr. bull.

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We aimed to establish current practice in the risk assessment of harm to others within general adult psychiatry and review risk assessment documentation in use. Consultants working across 66 randomly selected trusts across England were surveyed. A qualitative analysis of risk assessment documentation was carried out. RESULTSData were obtained from 45 trusts (68%). Consultants reported that 30 (67%) of the trusts had standardised forms for risk assessment. Forty-one forms were subjected to content analysis. Wide variation was found in the methods used to identify risk factors and in approaches to quantifying risk. CLINICAL IMPLICATIONSCurrent risk assessment practice is highly variable, indicating a lack of consensus about suitable methods.

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Risk assessment is inseparable from risk management

Cited by 16 publications

References 17 publications

Susceptibility (risk and protective) factors for in-patient violence and self-harm: prospective study of structured professional judgement instruments START and SAPROF, DUNDRUM-3 and DUNDRUM-4 in forensic mental health services

Susceptibility (risk and protective) factors for in-patient violence and self-harm: prospective study of structured professional judgement instruments START and SAPROF, DUNDRUM-3 and DUNDRUM-4 in forensic mental health services

Therapeutic uses of security: mapping forensic mental health services by stratifying risk

Assessing violence risk in general adult psychiatry

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