Implementing violence and incident reporting measures on a forensic mental health unit

Abstract

The assessment of risk and prediction of violence in mental health units can play a large role in creating a safer environment for both the staff and the patients. Nurses in forensic units are in a unique position in regards to assessment of violence as they spend a great deal of time with the patients. Nurses on a forensic mental health unit scored the Brøset Violence Checklist (BVC) twice daily for 12 weeks for all patients either resident on or admitted to the unit (N = 46). The Staff Observation Aggression Scale-Revised (SOAS-R) was used to report any adverse incidents (N = 51). Data were examined at the both the item and scale level. Main results showed the area under the curve values of the BVC score, slide rule, and the sum of BVC and slide rule score in turn demonstrated strong predictive accuracy for inpatient aggression (0.68–0.73). Through logistic regression analyses the BVC uniquely predicted inpatient aggression but adding the slide rule did not improve prediction. Predictive accuracy was found across three diagnostic groups – dementia, psychosis and substance use disorders. These results provide further support on the predictive accuracy of the BVC for short-term violence in forensic mental health settings.

Keywords:

• BVC
• SOAS-R
• structured clinical judgement
• violence prediction
• risk assessment

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. These AUC values are very high according to conventional standards (Rice & Harris, 2005). This may reflect the overlap in the item content of the BVC and the criterion of interest (e.g. current presence of any physically or verbally aggressive behaviors). See Method for further details.

Additional information

Funding

This work was supported by Faculty Research Grant from the Centre for Forensic Behavioural Sciences and Justice Studies, University of Saskatchewan.