The predictive validity and practical utility of structured schemes used to assess risk for aggression in psychiatric inpatient settings |
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| Affiliation: | 1. Department of Oceanography, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada;2. School of Ocean Sciences, Bangor University, Menai Bridge, Anglesey LL595AB, UK;1. St Andrew’s Healthcare, Cliftonville Road, Northampton, NN1 5DG, UK;2. University of Northampton, Park Campus, Boughton Green Road, Northampton, NN2 7AL, UK;3. University of Brighton, Falmer, BN1 9PH, UK;1. Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King''s College London, London, UK;2. Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA;3. Department of Old Age Psychiatry, Institute of Psychiatry, King''s College London, London, UK;4. NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King''s College London, London, UK;5. Département de Psychiatrie, Université de Montréal, Montréal, QC, Canada;1. Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK;2. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden |
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| Abstract: | There has been increased interest in structured schemes for the assessment of risk for aggression within inpatient psychiatric settings. The most commonly utilized schemes are those previously developed to assess risk for prisoners being considered for release on parole and for forensic psychiatric patients being considered for discharge from the hospital to the community. Few structured schemes have been developed with the explicit aim of assessing risk for aggression in the inpatient setting. Recent research utilising a variety of risk assessment schemes has revealed reasonable predictive validity. This narrative review summarizes and appraises this expanding literature within the context of risk assessment decision making tasks typically undertaken by psychiatric unit staff. It is concluded that a number of structured risk assessments schemes do have acceptable predictive validity. Unfortunately, many of the schemes tested are compromised by a lack of practical utility, and only a few are capable of contributing to the entire range of risk assessment decision making tasks required. Options for the application of structured risk assessment schemes are raised. |
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