Routine violence risk assessment in community forensic mental healthcare

• Published in: Behavioral sciences & the law 2010-05, Vol.28 (3), p.396-410
• Main Authors: van den Brink, Rob H. S., Hooijschuur, Alex, van Os, Titus W. D. P., Savenije, Wim, Wiersma, Durk
• Format: Article
• Language: English
• Subjects: Adult; Case Management - legislation & jurisprudence; Case managers; Commitment of Mentally Ill - legislation & jurisprudence; Community; Community Mental Health Services - legislation & jurisprudence; Criminology; Dangerous Behavior; Female; Forensic psychiatry; Health care; Home based treatment; Home Care Services - legislation & jurisprudence; Humans; Judgment; Male; Mental Disorders - diagnosis; Mental Disorders - psychology; Mental Disorders - therapy; Mental health care; Middle Aged; Needs Assessment - legislation & jurisprudence; Netherlands; Personality Assessment; Prisoners - legislation & jurisprudence; Prisoners - psychology; Professional judgments; Risk assessment; Risk Factors; Risk Reduction Behavior; Social Adjustment; Unmet needs; Violence; Violence - legislation & jurisprudence; Violence - prevention & control; Violence - psychology; Young Adult
• ISSN: 0735-3936; 1099-0798
• DOI: 10.1002/bsl.904

We developed a method for periodic monitoring of violence risk, as part of routine community forensic mental healthcare. The feasibility of the method was tested, as well as its predictive validity for violent and risk enhancing behavior in the subsequent months. Participants were 83 clients who received forensic psychiatric home treatment, and six case managers. The method proved feasible and informative. Violent and risk enhancing behavior could be predicted to a reasonable extent (AUC = .77, 95% CI = .70–.85; respectively .76, .70–.82). Dynamic risk factors had an incremental predictive value over static factors in the prediction of violent behavior (OR = 4.30, 1.72–10.73). The professional judgment of the case managers added further predictive power (OR = 2.16, 1.40–3.33), corroborating the structured professional judgment approach. Finally, unmet needs for care of the client were associated with a reduced risk for violent and risk enhancing behavior (OR = .80, 0.69–0.93, and 0.84, 0.72–0.97). This latter finding suggests that in cases with unmet needs the case manager saw opportunities to do something about the risk. Currently we are testing whether using the method actually prevents violence. Copyright © 2009 John Wiley & Sons, Ltd.