New Approach to Risk Assessment for Violent Behavior

the Psychiatry Advisor take:

Risk assessments for future violence should be changed to focus on factors that have a clear, causal to link to violence, as well as symptoms of a mental disorder and if an individual is taking their medication.

Jeremy Coid, MD, of the Wolfson Institute of Preventative Medicine at Queen Mary University of London, and colleagues examined 409 patients, both male and female, who were released from treatment in England and Wales back into their local community. They were assessed prior to their discharge, as well as six and 12 months afterwards. Details on violence behavior was obtained via case notes and a national police database.

Standard risk factors were not effective in identifying who would be violent and who wouldn’t. However, when a causal approach was used to confirm which risk and protective factors resulted in violence, it was effective, the researchers reported in the journal PLOS One.

Those factors included symptoms of a major mental disorder, the patients’ living condition, and whether they were taking medication. Also, the effects of violent thoughts, being in an unstable life situation, being under stress, and unable to cope were also three to four times stronger using the causal model than using the predictive approach.

“The future direction should be to identify risk factors that have causal relationships with violent behavior and not those which predict violent behaviors,” Coid said in a statement. “Risk factors, such as being young, male, of lower social class, with many previous violent convictions, may be good predictors, however, none of these factors are truly causal.”

What Psychiatrists Need to Know About Violence
Standard risk factors were not effective in identifying who would be violent, but a causal approach was successful.

In a study published in PLOS One, researchers  have proposed an entirely new approach to risk assessment for future violence. Previous approaches have relied on looking at risk factors that happen to be linked to, but may not cause, violence, for example, being young, male, of lower social class, with previous violent convictions.

The new approach is instead based on identifying risk factors that have a clear causal link to violence, and include symptoms of major mental disorder, the patient's living condition, and whether they are taking medication.

Over 300 risk assessment instruments are currently used by psychiatrists, psychologists, and probation officers to assess the risks of violence and sexual offending among psychiatric patients, prisoners, and the general population. The authors say that producing risk assessment instruments has become an 'industry' and new ones are being produced annually.

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