Mental Illness and Serious Harm to Others - University of Liverpool

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.
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