Structured assessments for imminent aggression in mental health and correctional settings: Systematic review and meta-analysis.

Violence is a common phenomenon both in regular and forensic psychiatric settings, and has a profound impact on staff and other patients. Insight into the individual risk factors associated with violence in forensic psychiatric settings is rare and is therefore the subject of this research. A retrospective file study in three medium security units in Flanders was conducted to compare non-violent inpatients with inpatients who engaged in (verbal and physical) violent behavior. Binary logistic regression analyses were used to examine which variables contributed independently to the risk of violence. The results showed that absconding during treatment was independently associated with physical violence. A personality disorder diagnosis and general non-compliance with treatment were associated with verbal violence. Both types of violence predicted early termination of treatment. Contrary to previous research, the results from the risk assessment tools were not associated with inpatient violence. Clinical implications are discussed and include, among others, that clinicians should remain vigilant for early warning signs of non-compliance during treatment.

Risk Factors Associated With Inpatient Violence During Medium Security Treatment

The contribution of dynamic risk factors in predicting aggression: a systematic review including inpatient forensic and non-forensic mental health services

Purpose To implement structured violence risk assessment (VRA) using the Dynamic Appraisal of Situational Aggression (DASA) on a 25-bed, adult, inpatient psychiatric unit. Design and methods Inpatient DASA screening for 13 weeks with nursing communication orders (NCOs) to highlight patients at high risk for violence. Pre/posttests measured registered nurse (RN) knowledge and perceptions of the DASA. Findings DASA completion rate equaled 81.8% with an NCO issue rate of only 32.8%. RN perceptions of the DASA were positive, and knowledge of structured violence risk assessment increased. Practice implications Structured violence risk assessment with the DASA is feasible and well-accepted on psychiatric units.

Implementation of the dynamic appraisal of situational aggression in inpatient mental health

Background: A new short-term risk assessment instrument, the Mechanical Restraint – Confounders, Risk, Alliance Score (MR – CRAS) checklist, including three subscales with altogether 18 ite...

Construct validity of the Mechanical Restraint - Confounders, Risk, Alliance Score (MR-CRAS): a new risk assessment instrument.

The assessment of risk and prediction of violence in mental health units can play a large role in creating a safer environment for both the staff and the patients. Nurses in forensic units are in a unique position in regards to assessment of violence as they spend a great deal of time with the patients. Nurses on a forensic mental health unit scored the Broset Violence Checklist (BVC) twice daily for 12 weeks for all patients either resident on or admitted to the unit (N = 46). The Staff Observation Aggression Scale-Revised (SOAS-R) was used to report any adverse incidents (N = 51). Data were examined at the both the item and scale level. Main results showed the area under the curve values of the BVC score, slide rule, and the sum of BVC and slide rule score in turn demonstrated strong predictive accuracy for inpatient aggression (0.68–0.73). Through logistic regression analyses the BVC uniquely predicted inpatient aggression but adding the slide rule did not improve prediction. Predictive accuracy was fo...

Implementing violence and incident reporting measures on a forensic mental health unit

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Implementing violence and incident reporting measures on a forensic mental health unit