Currently, psychiatrists, psychologists, and probation officers use more than 300 risk assessment instruments to predict the risks of physical and sexual violence among psychiatric patients, prisoners, and the general population.
In a new study, researchers at Queen Mary, University London (QMUL) propose that these risk assessment instruments have become an ‘industry’ and that none of the new instruments have any advantage over the older ones. In fact, say the researchers, their best predictions for future violence are incorrect 30 percent of the time.
Instead, the researchers have proposed an entirely new approach to risk assessment for future violence. The new approach would be 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.
This is different from previous approaches which have relied on looking at risk factors that happen to be linked to, but may not cause, violence. For example these might include being young, male, of lower social class, or having previous violent convictions.
“Researchers have become too obsessed with predicting whether a patient will be violent in the future, rather than looking for the causes of why they become violent. While it is helpful to know that a patient has a high or low risk of being violent if you release them from hospital, this is not going to tell you what you should do to stop them being violent,” said first author Professor Jeremy Coid from QMUL’s Wolfson Institute of Preventative Medicine.
“It is more important to know which factors are causally related because these are the factors that must be the targets for future treatments and management interventions if the aim is to prevent violence happening in the future.”
For the study, researchers followed 409 male and female patients who had been discharged from medium secure services in England and Wales and released into the community. The participants received assessments with two ‘state-of-the-art’ assessment instruments prior to their release, then after six and 12 months following discharge. Information on violence was gathered via individual case notes and a search of the police national computer.
The team’s analysis suggests that the standard risk factors were poor in identifying who would commit violent acts and who would not.
When the researchers used a causal approach to confirm which risk and protective factors resulted in violence, the findings were very different. They found that symptoms of major mental disorders, the patients’ living conditions, and whether they were taking medication, were highly important factors. 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 traditional approach.
“The future direction should be to identify risk factors that have causal relationships with violent behavior and not those which predict violent behavior. 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,” said Coid.
The findings are published in PLOS One.
Source: Queen Mary, University of London