Predicting Inpatient Aggression in Forensic Services Using Remote Monitoring Technology: Qualitative Study of Staff Perspectives.

Ben Greer,Matteo Cella,Til Wykes,Katie Newbery

doi:10.2196/15620

Abstract

BackgroundMonitoring risk of imminent aggression in inpatient forensic mental health services could be supported by passive remote monitoring technology, but staff attitudes toward the relevance and likelihood of engagement with this technology are unknown.ObjectiveThis study aimed to explore staff views, specifically potential benefits and implementation barriers, on using this technology for monitoring risk of inpatient aggression.MethodsWe conducted semistructured focus groups with nurses in an inpatient forensic mental health service. We used thematic analysis with two independent raters to identify themes and subthemes related to staff attitudes toward passive remote monitoring. We subsequently checked with members to ensure the validity of the themes identified by the raters.ResultsFrom January to March 2019, a total of 25 nurses took part in five focus groups. We identified five main themes, one of which concerned the potential benefits that passive remote monitoring could provide for monitoring risk of aggression. Staff suggested it could provide an early warning of impending aggression and enable support to be provided earlier. The remaining themes concerned implementation barriers, including risks to the users’ physical and mental well-being; data security concerns and potential access by third parties; the negative impact of a constant stream of real-time data on staff workload; and design characteristics and user awareness of the benefits of passive remote monitoring.ConclusionsPassive remote monitoring technology could support existing methods of monitoring inpatient aggression risk, but multiple barriers to implementation exist. Empirical research is required to investigate whether these potential benefits can be realized, and to identify ways of addressing these barriers to ensure acceptability and user engagement.

Highlights

Infrequent structured risk assessments for inpatient aggression cannot detect rapid, momentary changes in individual risk factors, limiting their ability to predict imminent aggression
Developments in passive remote monitoring technology mean that factors previously associated with aggression cross-sectionally can be monitored continuously, in real time
Emerging evidence indicates that passive remote monitoring technology can be used to identify changes in these parameters from 1 to 30 minutes before the observable act of aggression [8,9], and with greater temporal precision than existing risk assessments alone. Monitoring these parameters in real time could identify a reliable psychophysiological signature of when aggression may be more likely, enabling support to be offered before this behavior escalates

Summary

Introduction

Background Infrequent structured risk assessments for inpatient aggression cannot detect rapid, momentary changes in individual risk factors, limiting their ability to predict imminent aggression. Developments in passive remote monitoring technology (ie, wearable sensors) mean that factors previously associated with aggression cross-sectionally can be monitored continuously, in real time. Emerging evidence indicates that passive remote monitoring technology can be used to identify changes in these parameters from 1 to 30 minutes before the observable act of aggression [8,9], and with greater temporal precision than existing risk assessments alone. Monitoring these parameters in real time could identify a reliable psychophysiological signature of when aggression may be more likely, enabling support to be offered before this behavior escalates. Monitoring risk of imminent aggression in inpatient forensic mental health services could be supported by passive remote monitoring technology, but staff attitudes toward the relevance and likelihood of engagement with this technology are unknown

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