Patients' Self-Assessment May Help Assess Violence Risk

The ability to predict which individuals with mental illness are at greatest risk of committing violent acts is an increasing concern for psychiatrists, mental health professionals, and the general public, particularly in the wake of several mass murders perpetrated by individuals who may have had a mental illness. One strategy that shows promise and is described in a newly published study is asking the patients to provide their own assessment of their risk of becoming violent. Writing in the May Psychiatric Services, Jennifer Skeem, Ph.D., of the Department of Psychology and Social Behavior at the University of California, Irvine, and colleagues report that "Patients' self-perceptions [of violence risk] hold promise as a method for improving risk assessment in routine clinical settings."

They compared the predictive accuracy of two risk-assessment methods that are easy to use in routine clinical settings—brief risk-assessment tools and patients' self-perceptions of risk—in "high-risk" inpatients who had a mental illness other than schizophrenia and had a comorbid substance use disorder. During interviews at a large psychiatric hospital with the 86 patients, the researchers used the Clinically Feasible Iterative Classification Tree and the Modified Screening Tool. They also had the patients indicate their own perceptions of their risk for violence. Two months after hospital discharge, the participants completed a follow-up interview in which they were asked about violence since discharge. The patients' self-perceptions turned out to be more accurate predictors than did the two assessment tools.

The researchers noted that they do not know if these findings will generalize from a research to a clinical context and that using self-perceptions should be one tool in violence risk assessment and "not a replacement" for other assessment methods.

Read more about the study in the new issue of Psychiatric Services here. Also see Psychiatric News here.

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