Abstract
BackgroundViolence risk assessment is a routine part of clinical services in mental health, and in particular secure psychiatric hospitals. The use of prediction models and risk tools can assist clinical decision-making on risk management, including decisions about further assessments, referral, hospitalization and treatment. In recent years, scalable evidence-based tools, such as Forensic Psychiatry and Violent Oxford (FoVOx), have been developed and validated for patients with mental illness. However, their acceptability and utility in clinical settings is not known. Therefore, we conducted a clinical impact study in multiple institutions that provided specialist mental health service.MethodsWe followed a two-step mixed-methods design. In phase one, we examined baseline risk factors on 330 psychiatric patients from seven forensic psychiatric institutes in China. In phase two, we conducted semi-structured interviews with 11 clinicians regarding violence risk assessment from ten mental health centres. We compared the FoVOx score on each admission (n = 110) to unstructured clinical risk assessment and used a thematic analysis to assess clinician views on the accuracy and utility of this tool.ResultsThe median estimated probability of violent reoffending (FoVOx score) within 1 year was 7% (range 1–40%). There was fair agreement (72/99, 73% agreement) on the risk categories between FoVOx and clinicians’ assessment on risk categories, and moderate agreement (10/12, 83% agreement) when examining low and high risk categories. In a majority of cases (56/101, 55%), clinicians thought the FoVOx score was an accurate representation of the violent risk of an individual patient. Clinicians suggested some additional clinical, social and criminal risk factors should be considered during any comprehensive assessment. In addition, FoVOx was considered to be helpful in assisting clinical decision-making and individual risk assessment. Ten out of 11 clinicians reported that FoVOx was easy to use, eight out of 11 was practical, and all clinicians would consider using it in the future.ConclusionsClinicians found that violence risk assessment could be improved by using a simple, scalable tool, and that FoVOx was feasible and practical to use.
Highlights
Violence risk assessment is a routine part of clinical services in mental health, and in particular secure psychiatric hospitals
A recent meta-analysis has suggested that existing violence risk assessment tools such as Historical, Clinical, Risk Management-20 (HCR-20) and Psychopathy Checklist Revised (PCL-R) have poor to moderate predictive validity in Chinese settings [7], which corresponds with poor validity in field studies in people leaving hospital and prison in other countries [8, 9]
We manually reviewed all medical files of patients under forensic psychiatric assessments in Hunan to extract data on variables included in the Forensic Psychiatry and Violent Oxford (FoVOx) risk assessment tool
Summary
Violence risk assessment is a routine part of clinical services in mental health, and in particular secure psychiatric hospitals. A recent meta-analysis has suggested that existing violence risk assessment tools such as Historical, Clinical, Risk Management-20 (HCR-20) and Psychopathy Checklist Revised (PCL-R) have poor to moderate predictive validity in Chinese settings [7], which corresponds with poor validity in field studies in people leaving hospital and prison in other countries [8, 9]. Another limitation of current instruments has been that they are often resource-intensive and time-assuming. Individual studies have found 6% reoffend within 6 months of discharge in Germany [13], and 49% repeat offend within around 3 years in England [14]
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