The assessment of dangerousness and predictions of violence: Recent research and future prospects

Litwack, Thomas R.; Kirschner, Stuart M.; Wack, Renate C.

doi:10.1007/bf01064602

Cited by 40 publications

(24 citation statements)

References 32 publications

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“…None suggest a level of accuracy in prediction that would encourage decision‐making on the basis of a score alone; however, many writers agree that they can significantly inform and guide clinical assessments (e.g. Hall 1988, Litwack et al . 1993).…”

Section: An Overview Of Published Actuarial Risk Assessment Instrumentsmentioning

confidence: 99%

The use of discharge risk assessment tools in general psychiatric services in the UK

Stein

2002

Psychiatric Ment Health Nurs

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Closure of asylums dismantled a system of risk control based on containment, resulting in a rise in homicides and suicides by discharged patients. Remedial action centred on a structured approach to managing multidisciplinary care (the Care Programme Approach) and a system of independent inquiries into homicides. A need for better discharge risk assessment was identified by government and health professions. The literature points to inherent limitations in the predictive power of actuarially based tools, restricting them to augmenting clinical judgement. This paper addresses the development and effective use of tools to predict risk to patients and public following discharge into the community. Methods used were: (i) a questionnaire to NHS Trusts in the UK; (ii) an analysis of documentation on tools in use; and (iii) interviews of hospital and community mental health teams at eight NHS Trusts. Findings point to: (i) a sporadic development of risk assessment tools at Trust level; (ii) that this has been stimulated by clinical governance but is unguided by any coherent national strategy; and (iii) that information technology for risk data collection is not well used in the UK, where there is reliance on use of paper records and informal communication. The implications for management and health professions are discussed.

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Section: An Overview Of Published Actuarial Risk Assessment Instrumentsmentioning

confidence: 99%

The use of discharge risk assessment tools in general psychiatric services in the UK

Stein

2002

Psychiatric Ment Health Nurs

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“…Instead, the criterion is whether they used acceptable professional judgment in making these decisions about dangerousness. Courts have not typically found liability for failure to predict violence, but they have found liability for failure to assess the potential for violence thoroughly (Litwack, Kirschner, & Wack, 1993).…”

Section: Assessing Dangerousnessmentioning

confidence: 99%

Risk management and life-threatening patient behaviors

VandeCreek

Knapp

2000

J. Clin. Psychol.

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“…Generally, observer-rated scales, e.g., the Brief Psychiatric Rating Scale [Overall and Gorham, 1962], self-report questionnaires, e.g., the Special Hospital Assessment of Personality and Socialization [Blackburn, 1986], and projective techniques, e.g., the Rosenzwieg Picture Frustration Test [Edmunds and Kendrick, 1980] have been applied. However, their relevance in violence risk assessment has not been convincing, and after an optimistic period during the 1980s, the past decade showed a dramatic decrease in the number of studies in this specific area of research [e.g., Litwack et al, 1993;Otto, 2000]. This invites further studies to improve clinical application and measurement of dynamic clinical factors that may be of relevance to risk assessment.…”

Section: Introductionmentioning

confidence: 99%

SCL‐90‐R profiles in a sample of severely violent psychiatric inpatients

Bjørkly¹

2002

Aggressive Behavior

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A sample of 39 patients who had committed serious violent acts toward others were assessed with the revised Symptom Checklist (SCL-90-R). The SCL-90-R is a self-report symptom inventory for the measurement of psychopathology in psychiatric and medical patients. In addition to the patients' selfreport, an observer-rated SCL-90-R was obtained. This was accomplished by letting one pair of nurses complete SCL-90-R ratings for each patient. The first aim of the study was to compare the SCL-90-R self-report scores of the patient sample with the psychiatric inpatient norms [Derogatis LR (1992): Clinical Psychometric Research Inc]. Another purpose of this study was to explore possible trends of discordance between the observer ratings and the self-reports of the study group. Always considering the limitations of the small sample, it was nevertheless also of interest to look for possible sex differences and differences between violent subgroups and between diagnostic groups in the selfreported scores as well as in the observer ratings. The most striking findings of the present study were that the self-reported scores were lower than the inpatient norms for SCL-90-R and that the patients' self-reported levels of distress were significantly lower than those found in the observer ratings. Underreporting of psychopathology as a marker of violence risk is discussed in light of these findings. In this study, women reported higher distress levels than men in the Interpersonal Sensitivity symptom dimension. There were no significant differences concerning SCL-90-R ratings between patients who had committed homicide, attempted homicide, or physically assaulted another person in a serious but not life-threatening way. Aggr. Behav. 28:446-457, 2002. r

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The assessment of dangerousness and predictions of violence: Recent research and future prospects

Cited by 40 publications

References 32 publications

The use of discharge risk assessment tools in general psychiatric services in the UK

The use of discharge risk assessment tools in general psychiatric services in the UK

Risk management and life-threatening patient behaviors

SCL‐90‐R profiles in a sample of severely violent psychiatric inpatients

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