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Risk analysis: An integrated approach to the assessment and management of aggression/violence in mental health

Published online by Cambridge University Press:  01 June 2009

Scott Lamont  and
Scott Brunero
Scott Lamont*
Affiliation:
Clinical Nurse Consultants, Prince of Wales Hospital, NSW, Australia
Scott Brunero
Affiliation:
Clinical Nurse Consultants, Prince of Wales Hospital, NSW, Australia
*
Correspondence to: Scott Lamont, Prince of Wales Hospital, NERU, EBB, rm 7, High St, Randwick, 2031 NSW, Australia. Tel: +61 2 9382 2793; Fax: +61 2 9382 3035; E-mail: [email protected]
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Abstract

Assessing a patient's risk of violent behaviour, predicting dangerousness and the development of a subsequent management plan have become integral and important aspects of contemporary mental health practices. What is less clear, and much discussed within the literature, is how we should best implement risk assessment and risk management practices within mental health care. The aim of this paper is to critically discuss risk assessment practices in order to propose a systematic approach to the effective assessment and management of aggression and violence in mental health settings. A critical review of the risk literature in mental health was undertaken. The literature search highlighted different generations or approaches to risk assessment methodology, which were critically reviewed. From this critical review a proposed model entitled ‘risk analysis’ is argued from the appraisal and critique of the literature as a more encompassing and collaborative approach to the assessment and management of risk.

Keywords

Risk assessmentrisk managementviolenceaggressionmental healthpsychiatry
Type
Original Article
Information
Journal of Psychiatric Intensive Care , Volume 5 , Issue 1 , June 2009 , pp. 25 - 32
Copyright
Copyright © NAPICU 2009

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References

Abderhalden, C., Needham, I., Miserez, B., Almvik, R., Dassen, T., Haug, H. and Fischer, J. (2004) Predicting inpatient violence in acute psychiatric wards using the Broset-Violence-Checklist: A multicentre prospective cohort study. Journal of Psychiatric and Mental Health Nursing. 11: 422–427.CrossRefGoogle ScholarPubMed
Almvik, R., Woods, P. and Rasmussen, K. (2000) The Broset Violence Checklist (BVC): Sensitivity, specificity and inter-related reliability. Journal of Interpersonal Violence. 15: 1284–1296.CrossRefGoogle Scholar
Bowers, L. (2005) Preface. In: Muir-Cochrane, E., Wand, T. Contemporary issues in risk assessment and management in mental health. Greenacres, Australian & New Zealand College of Mental Health Nurses.Google Scholar
Campbell, M. and Chaplin, R. (2001) Improving the assessment of risk violence: A clinical audit of case note documentation. Psychiatric Bulletin. 25: 250–252.CrossRefGoogle Scholar
Canter, D.V. and Zukauskiene, R. (2008) Psychology and Law: Bridging the gap. Surrey: Ashgate Publishing Limited.Google Scholar
Davison, S. (2005) The management of violence in general psychiatry. Advances in Psychiatric Treatment. 11: 362–370.CrossRefGoogle Scholar
Delaney, J., Cleary, M., Jordan, R. and Horsfall, J. (2001) An exploratory investigation into the nursing management of aggression in acute psychiatric services. Journal of Psychiatric and Mental Health Nursing. 8(1): 77–84.Google Scholar
Doctor, R. (2004) Psychodynamic lessons in risk assessment and management. Advances in Psychiatric Treatment. 10: 267–276.CrossRefGoogle Scholar
Douglas, K., Cox, D. and Webster, C. (1999) Violence risk assessment: Science and practice. Legal and Criminological Psychology. 4(2): 149–184.CrossRefGoogle Scholar
Douglas, K., Ogloff, J. and Hart, S. (2003) Evaluation of a model of violence risk assessment among forensic psychiatric patients. Psychiatric Services. 54(10): 1372–1379.CrossRefGoogle 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
Grove, W. and Meehl, P.E. (1996) Comparative efficiency of informal (subjective, impressionistic) and formal (mechanical, algorithmic) prediction procedures: The clinical-statistical controversy. Psychology, Public Policy and Law. 2(2): 293–323.CrossRefGoogle Scholar
Grove, W., Zald, D.H., Lebow, B., Snitz, B. and Nelson, C. (2000) Clinical versus mechanical prediction: A meta-analysis. Psychological Assessment. 12(1): 19–30.CrossRefGoogle ScholarPubMed
Hare, R.D. (2003) Hare Psychopathy Checklist-Revised (PCL-R). 2nd Edition. Toronto Multi-Health Systems.Google Scholar
Harris, G.T., Rice, M.E. and Quinsey, V.L. (1993). Violent recidivism of mentally disordered offenders: the development of a statistical prediction instrument. Criminal Justice Behaviour. 20: 315–335.CrossRefGoogle Scholar
Harris, M. (1997) Training trainers in risk assessment. The British Journal of Psychiatry. 170(suppl. 32): 35–36.CrossRefGoogle Scholar
Holloway, F. (2004) Risk: More questions than answers. Invited commentary on... Psychodynamic methods in risk assessment and management. Advances in Psychiatric Treatment. 10: 273–274.CrossRefGoogle Scholar
Irwin, A. (2006) The nurse’s role in the management of aggression. Journal of Psychiatric and Mental Health Nursing. 13: 309–318.CrossRefGoogle ScholarPubMed
Kidd, B. (2003) The psychiatrist’s response to imminent violence – clinical practice guidelines improved practice? Psychiatric Bulletin. 27: 283–284.Google Scholar
Lewis, A. and Webster, C. (2004) General instruments for risk assessment. Current Opinion in Psychiatry. 17: 401–405.CrossRefGoogle Scholar
Maden, A. (2003) Standardised risk assessment: Why all the fuss? Psychiatric Bulletin. 27: 201–204.Google Scholar
McNeil, D.E., Binder, R.L. and Greenfield, T.K. (1988) Predictors of violence in civilly committed acute psychiatric patients. American Journal of Psychiatry. 145: 965–970.Google Scholar
McSherry, B. (2004) Risk assessment by mental health professionals and the prevention of future violent behaviour. Trends & Issues in Crime and Criminal Justice. 281. Australian Institute of Criminology. http://www.aic.gov.au/publications/tandi2/tandi281.pdfGoogle Scholar
Monahan, J. (1981) The Clinical Prediction of Violent Behaviour. Washington DC: US Department of Health and Human Services.Google Scholar
Morgan, S. (1998) Assessing and Managing Risk; Practitioner’s Handbook. The Sainsbury Centre for Mental Health. Brighton: Pavilion Publishing.Google Scholar
Morgan, S. (2000) Clinical Risk Assessment: A clinical tool and practitioner manual. The Sainsbury Centre for Mental Health. Brighton: Pavilion Publishing.Google Scholar
Muir-Cochrane, E. and Wand, T. (2005) Contemporary issues in risk assessment and management in mental health. Greenacres, Australian & New Zealand College of Mental Health Nurses.Google Scholar
NICE (2005) Violence: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments. London: NICE.Google Scholar
NICE (2007) Best Practice in Managing Risk: Principles and evidence for best practice in the assessment and management of risk to self and others in mental health. London: NICE.Google Scholar
O’Neill, D. (1999) Non-Fatal Workplace Violence: An epidemiological report and empirical exploration of risk factors. Dissertation: University of Nebraska.Google Scholar
RPsych (1996) Royal College of Psychiatrists Special Working Party on Clinical Assessment and Management of Risk. Assessment and clinical management of risk of harm to other people. Council Report CR 53.Google Scholar
Sawyer, A. (2005) From therapy to administration: Deinstitutionalisation and the ascendency of psychiatric ‘risk thinking’. Health Sociology Review. 14(3): 283–296.CrossRefGoogle Scholar
Society for Risk Analysis (2008) About the Society for Risk Analysis. http://www.sra.org/about.phpGoogle Scholar
Stein, W. (2002) The use of discharge risk assessment tools in general psychiatric services in the UK. Journal of Psychiatric and Mental Health Nursing. 9: 713–724.CrossRefGoogle ScholarPubMed
Steinert, T. (2002) Prediction of inpatient violence. Acta Psychiatrica Scandinavica. 106(Suppl.412): 133–141.CrossRefGoogle Scholar
Thomson, L.D.G. (2000) Management of schizophrenia in conditions of high security. Advances in Psychiatric Treatment. 6: 252–260.CrossRefGoogle Scholar
Trenoweth, S. (2003) Perceiving risk in dangerous situations: Risks of violence among mental health inpatients. Journal of Advanced Nursing. 42(3): 278–287.CrossRefGoogle ScholarPubMed
Webster, C.D., Douglas, K.S., Eaves, D. and Hart, S.D. (1997) HCR-20: Assessing risk for violence (version 2). Vancouver: Simon Fraser University and the Forensic Psychiatric Services Commission of British Columbia.Google Scholar
Witteman, C. (2004) Violent figures, risky figures. Invited commentary on psychodynamic methods in risk assessment and management. Advances in Psychiatric Treatment. 10: 275–276.CrossRefGoogle Scholar