Mental Health

Risk Evaluation for Violence Among Mentally Ill Patients Made Simple

By Drishya Nair | Update Date: Sep 15, 2012 06:51 AM EDT

Mental Health care professionals are often at risk of violence by the patients.

According to a new study by researchers from University of California, San Francisco, health professionals could benefit from a simple tool that would help them assess the risk more accurately.

The research was aimed at studying how accurately psychiatrists assessed the risk of violence by mentally ill patients admitted to psychiatric wards.

The first part of the study revealed that inexperienced psychiatric residents' evaluation of the risk of violence by patients was inaccurate and would not have been any different even if it had been assessed by chance, while veteran psychiatrists were moderately successful at estimating potential risk.

In the second part of the study, it was found that when the researchers tested the residents' evaluation data using the "Historical, Clinical, Risk Management-Clinical" (HRC-20-C) scale - a brief, structured risk assessment tool - it gave them results as accurate as those of faculty psychiatrists who had 15 years or more of experience.

"Similar to a checklist a pilot might use before takeoff, the HRC-20-C has just five items that any trained mental health professional can use to assess their patients," said lead author of the study and psychiatrist Alan Teo, MD, Medical Xpress reported.

"To improve the safety for staff and patients in high-risk settings, it is critical to teach budding psychiatrists and other mental health professionals how to use a practical tool such as this one."

The tool, HCR-20-C, was developed several years ago by researchers in Canada and was used in prisons and hospitals. However, in the U.S, such tools are only beginning to be used in hospitals, the report said.

"This is the first study to compare the accuracy of risk assessments by senior psychiatrists to those completed by psychiatric residents," said senior author Dale McNiel, PhD, UCSF professor of clinical psychology. "It shows that clinicians with limited training and experience tend to be inaccurate in their risk assessments, and that structured methods such as HCR-20-C hold promise for improving training in risk assessment for violence."

"The UCSF study was unusual," Teo added, "in applying a shorter version of the tool that could be more easily incorporated into clinical practice."

The researchers assessed the doctors' accuracy of finding potential violence in patients by comparing the assessments made by the doctors when a patient was admitted to the hospital, as to whether or not patients actually became violent later with the hopital staff.

The study included 151 violent and 150 non-violent patients, all of whom had severe mental illnesses and had been involuntarily admitted to the hospital.

The study was published in the journal Psychiatric Services.

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