Researchers have developed a simple tool to identify the risk of violence among acutely ill patients admitted to psychiatric units.
Mental health professionals are often asked to evaluate and manage the risk of violence among recently admitted patients.
In the first part of the research, led by psychiatrist Alan Teo, M.D., and his colleagues at the University of California – San Francisco, investigators learned that inexperienced psychiatric residents performed no better than they would have by chance in predicting risk of violence among newly admitted patients.
Veteran psychiatrists were only moderately successful.
However, the second part of the study showed that when researchers applied the information from the “Historical, Clinical, Risk Management–Clinical” (HCR-20-C) scale, young physicians ability to identify an individual’s potential for violence increased to a level nearly as high as that of faculty psychiatrists who had an average of 15 years more experience.
“Similar to a checklist a pilot might use before takeoff, the HCR-20-C has just five items that any trained mental health professional can use to assess their patients,” Teo said.
“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.”
Researchers have published the study in the journal Psychiatric Services.
Clinicians using the scale look for the following five characteristics in a patient:
- lack of insight;
- negative attitudes;
- active symptoms of major mental illness;
- unresponsiveness to treatment.
For each of these characteristics, the clinician assigns patients a 0 (absent), 1 (possibly present), or 2 (present).
The HCR-20-C tool was developed several years ago by researchers in Canada, where it is used in a number of settings such as prisons and hospitals. However, in the United States, structured tools such as the HCR-20-C are only beginning to be used in hospitals.
“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, Ph.D.
“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.”
Teo and his team assessed the doctors’ accuracy by comparing the risk assessments that they made at the time patients were admitted to the hospital, to whether or not patients later became physically aggressive toward hospital staff members, such as by hitting, kicking or biting.
The study included 151 patients who became violent and 150 patients who did not become violent. The patients in the study had severe mental illnesses, often schizophrenia, and had been involuntarily admitted to the hospital.