Mental Illness and Serious Harm to Others - University of Liverpool

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NHS National Programme on Forensic Mental Health Research and Development useful checklist and would perhaps fit here. The task then is to test for the extent to which a wide range of clinical disciplines will use such strategy in practice, and explicitly so in documentation, and whether it does appear to be useful. The real value of multi-disciplinary - indeed multi-person - input at this task has never been satisfactorily established. Should an additive model be applied to what is available, or should it be an averaging model, or a consensus one? What difference to an assessment statement does each route make? In turn, what difference does this make in practice? Work on polarisation in groups (Moscovici and Zavalloni, 1969; Myers and Lamm, 1976) suggests that there are no grounds for complacency in assumptions about multidisciplinary consensus being useful. There remains a place for naturalistic management studies. As methodology improves and satisfactory allowance can be made for relative times at risk, there is still much to learn in long-term follow-up. The case for adding more experimental designs is, however, also strong, as the 'second generation' studies from the USA noted above also show. 19
NHS National Programme on Forensic Mental Health Research and Development 5. Three High-Priority Research Questions In a field where there is so much to learn, prioritising is disproportionately hard, but the following are three suggestions at least for the main categories of question: 1. What is the long-term perspective on evolution of violence among people with mental illness? ❑ Is early onset of pre-psychotic symptom equivalents likely to be relevant to later violence or aggression? ❑ What continuity is there, if any, between inpatient and outpatient violence patterns? ❑ What personal or situational characteristics enable those who desist from violence to do so in the long term? 2. Can risk assessment and management be improved in clinical practice? ❑ What is the correlation between routine assessment by clinicians of the five key risks (violence to others, suicide, other self-harm, substance misuse, and absconsion / non-compliance) according to transparent individual clinical assessments and simple actuarial tools? ❑ What factors do clinicians rate on a case-by-case basis / overall as relevant to assessment of risk that are not included in actuarial tools? ❑ With respect to risk assessment, what do clinicians agree is workable in practice? ❑ When formally asked, what factors do the individual patients concerned rate as pertinent to the risks, to what extent have these been identified in routine clinical assessment and to what extent by actuarial tools? ❑ What is the correlation between individual clinical assessments and the collective team view before and after discussion? ❑ Is there a demonstrable association between assessment of risk and the clinical management and treatment plan? ❑ Is there an association between close agreement at each point and relative safety, dissonance at each point and relative harm? Is any one step more critical than others? 3. For people judged as at serious risk of illness relapse and potential for violence, what management is most effective? ❑ A randomised trial of formal versus informal supervision in the community for people with mental illness and a demonstrated propensity for violence may be possible where no restriction order on discharge has been imposed by the Court. ❑ A randomised trial and follow-up of atypical antipsychotic medication would be useful. ❑ Trials of effectiveness of training / professional development of staff in specific areas / tasks, for example on communication techniques in crisis, and limiting development of high expressed emotion, would be of value. 20
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Mental Illness and Serious Harm to Others - University of Liverpool

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