START Changing Practice: Implementing a Risk Assessment and Management Tool in a Civil Psychiatric Setting

Abstract

Listen

Translate article

The assessment and management of risk for violence among individuals with a mental illness, traditionally the responsibility of specialized forensic institutions, are now becoming increasingly necessary in civil mental health services. The Short Term Assessment of Risk and Treatability (START) is a patient-centered scheme informing multiple risk domains through a comprehensive assessment of dynamic risk factors and strengths, based on a fixed set of definitions. However, there is a dearth of literature on the implementation of such tools in real life mental health settings, their relation to future behavior and their perceived usefulness in clinical settings. In this article, we describe the process of implementing the START on a civil psychiatric hospital unit in Canada taking into account typical barriers to the dissemination of evidence-based practices. The results of a longitudinal prospective mixed method (qualitative and quantitative) implementation study indicate that the START was well integrated into the unit's clinical and administrative activities. In these times of financial constraints in mental health services, as well as the increased pressure of mental health services to manage a wide variety of challenging behaviors, risk management tools can provide help in improving patient care and empowering staff to better understand violence and other challenging behaviors. This paper concludes with a discussion of the need to develop implementation research in the field of forensic mental health services in order to reduce the gap between research and practice.