Prevalence and predictors of verbal aggression in a secure mental health service:use of the HCR-20

Despite evidence about the negative effects of verbal aggression in mental health wards there is little research about its prevalence or about the factors that predict the behaviour among inpatients. This study aimed to determine the prevalence of verbal aggression in a secure mental health service, and to examine the relationship of verbal aggression with risk factors for aggression in the risk assessment tool HCR-20 in order to establish whether, and with which factors, the behaviour can be predicted. Verbal aggression was measured using the Overt Aggression Scale (OAS) over a 3-month period across a heterogeneous patient group (n = 613). Over half the patients (n = 341, 56%) engaged in 1594 incidents of verbal aggression. The HCR-20 total, clinical, and risk management subscale scores predicted verbal aggression, though effect sizes were not large. Item-outcome analysis revealed that impulsivity, negative attitudes, and non-compliance with medication were the best predictors of verbal aggression and, therefore, should be targeted for intervention. There are key synergies between factors predicting verbal aggression and the core mental health nursing role. Nurses, therefore, are in a prime position to develop and implement interventions that may reduce verbal aggression in mental health inpatients

The utility of the Historical Clinical Risk -20 Scale as a predictor of outcomes in decisions to transfer patients from high to lower levels of security-A UK perspective

<p>Abstract</p> <p>Background</p> <p>Structured Professional Judgment (SPJ) approaches to violence risk assessment are increasingly being adopted into clinical practice in international forensic settings. The aim of this study was to examine the predictive validity of the Historical Clinical Risk -20 (HCR-20) violence risk assessment scale for outcome following transfers from high to medium security in a United Kingdom setting.</p> <p>Methods</p> <p>The sample was predominately male and mentally ill and the majority of cases were detained under the criminal section of the Mental Health Act (1986). The HCR-20 was rated based on detailed case file information on 72 cases transferred from high to medium security. Outcomes were examined, independent of risk score, and cases were classed as "success or failure" based on established criteria.</p> <p>Results</p> <p>The mean length of follow up was 6 years. The total HCR-20 score was a robust predictor of failure at lower levels of security and return to high security. The Clinical and Risk management items contributed most to predictive accuracy.</p> <p>Conclusions</p> <p>Although the HCR-20 was designed as a violence risk prediction tool our findings suggest it has potential utility in decisions to transfer patients from high to lower levels of security.</p

Pianisten Hans Roland Orgenius: Först uppåtgående jazzstjärna sedan utkastad från jazzens finrum

Den unge blinde Hans Roland Orgenius hade fått en gedigen musikutbildning på Blindinstitutet Tomteboda när han vid 15 års ålder beslöt att prova på en karriär som jazzpianist. Efter skolan sökte han arbete på Sveriges Radio, där han fick anställning som pianist för att spela i flera radioprogram, ofta tillsammans med sin något äldre kamrat från Tomteboda, Reinhold Svensson. Han började också få spelningar i Stockholmstrakten och blev mycket populär framför allt för sitt sätt att spela boogie-woogie. På somrarna gjorde han turnéer på landsbygden bl a med sångaren Chris Dane. Hans framgångar gav honom skivkontrakt, först med Sonora och sedan Columbia, och han spelade in flera 78-varvsskivor under åren 1952-54. Vid turnéer i Frankrike och Tyskland 1953 och 1954, kom han i kontakt med många utländska jazzstjärnor som Dizzy Gillespie, Charlie Parker och sångerskan Sarah Vaughan. När jazzscenen förändrades vid ingången till sextiotalet, fick många jazzmusiker svårigheter och en del slutade att spela. Orgenius kunde dock hålla sig kvar i branschen som turnerande musiker, men det blev inga flera skivinspelningar. och press och radio förlorade intresset för honom. Han fortsatte att turnera även i Norge och Finland och framhärdade med detta till 1981 då han avslutade sin yrkeskarriär

Structured clinical assessment and management of risk of violent recidivism in mentally disordered offenders

Background: The assessment of risk of violence among mentally disordered offenders has been a controversial but well-researched area in forensic psychology and psychiatry during the last decades. The main focus of this research has been on the predictive validity of various risk factors and methods of combining risk factors to gain the highest possible predictive accuracy. In the present thesis, risk assessment is defined more broadly than predictive accuracy, and also includes process factors, risk-management, and the communication and decision-making associated with risk of violence. The overall aim of this thesis was to explore the process of structured risk assessment in its naturalistic clinical setting. Method: Four different samples were across 5 studies. A guideline for structured clinical risk assessment, Historical-Clinical-Risk assessment (HCR-20), was used in the first 4 studies. The first study used a 6 raters x 6 patients design to establish inter-rater reliability and validity of the HCR-20. 54 forensic patients were followed over time and monitored for inpatient violence and violence after discharge during three risk-management conditions in study 2. A sample of 40 nurses, assessing the same 8 patients, was included in studies 3 and 4. Finally study 5 included a sample of 88 decisionmakers, divided into 3 groups; Clinicians, Criminal law professionals and Controls. Results: The HCR-20 was found to have reasonable reliability and validity in study 1. The main finding in study 2 was that the predictive accuracy of the HCR-20 was influenced by the intensity of risk management (AUC .64 compared to .82). In study 3 it was found that structured clinical risk assessment was not "immune" to emotional bias in the assessment process. 43% of the variance in risk-scores could be attributed to the assessors' emotions towards the patient. The information utilised to make the assessment, and how the assessor values it, also influenced the assessments in study 4. Placing value on personal interaction was more associated with inpatient violence than with recidivism. In study 5 we found that the inclination of making release decisions was greatly influenced (eta2=.58 ) by the prospect of making false negative error of judgement. Conclusions: Structured clinical risk assessments can be undertaken in a reliable and valid way in forensic clinical settings. Attention needs to be paid to factors that might influence the outcome of the assessments and the risk-management decisions that are the consequence of risk assessment. These factors can be emotional biases, evaluation of different kinds of information that form the basis for the process. There needs to be an awareness of other factors than probabilities that influence decisions about risk. It is suggested that future descriptive, as opposed to prescriptive, research is needed on the processes and influences on risk assessments, as they are actually conducted by clinicians in actual forensic, psychiatric and correctional settings, and not by researchers or trained research assistants