UP-TO-DATE RESEARCH –Feasibility of a Violence Risk Assessment Tool in Forensic Mental Health

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Situation to date:
Currently, the assessment of violence risk amongst individuals with mental disorder does not fall within an agreed practice. One purpose of the EU-VIORMED project is to redefine and standardize assessment tools in order to find out how to improve the diagnosis and the effectiveness of treatments for violence risk in Severe Mental Disorders (SMDs) and advance the quality of forensic psychiatric care across Europe.

The study:
A recent work, published in Frontiers in Psychiatry (Impact Factor 3.532), examines the Forensic Psychiatry and Violence Oxford (FoVOx) tool, a risk assessment guide whose feasibility is meant to be tested also in the EU-VIORMED Project. In this study, Robert Cornish and colleagues evaluated the tool in terms of acceptability, feasibility and practicality.

The protocol used a mixed methods approach:

  1. first of all, the study team accessed the electronic healthcare record of 84 consecutive discharges from six secure psychiatric hospitals in one region in England over two years in order to obtain the information required to calculate their FoVOx score;
  2. then, the 11 clinicians responsible for patients’ discharge underwent an interview regarding each discharge;
  3. lastly, members of the study team shared the patients’ FoVOx scores with the clinicians and assessed their views on the use of the FoVOx tool, asking if they considered FoVOx scores accurate and useful and surveying them about current risk assessment practice on discharge.

On 67% of the occasions (56 out of 84), the FoVOx score was felt by the clinician as an accurate representation of the violence risk at discharge. In addition, 58% of clinicians reported that it would have been helpful to know FoVOx scores at discharge. For some patients, clinicians revised their view about future violent re-offending risk to a higher level after being informed on the FoVOx score. These findings suggest that probability-based FoVOx scores might assist clinical decision making. The FoVOx tool was praised for its ease, brevity, speed, availability online, enhanced information sharing, reassurance for clinicians, identification of unaddressed or underweighted risk factors and utility in guiding community management after discharge. After reviewing individual discharges, 90% of clinicians reported that the FoVOx tool is practical to use, and 7 out of 11 (64%) reported that they would use it in the future. Thus, as a whole, the opinions on FoVOx were consistently positive.

Take-home message:
The EU-VIORMED Project pursues the delivery of more accurate means of assessment tools which can predict the risk of violence in psychiatric services and more effective means to reduce it, supporting the harmonization of forensic psychiatric care pathways in order to improve the quality of forensic psychiatric care. The aforementioned findings emphasize the need to identify a practical and adequate risk assessment tool that could be helpful as an adjunct to clinical decision-making at the point of discharge of the patients.
Although further elements of validation are required comparing the accuracy of FoVOx to clinician’s judgment, this study supports the integration of such instruments into patient care.

The article full text is available at:

Full reference:
Cornish R, Lewis A, Parry OC, Ciobanasu O, Mallett S, Fazel S. A Clinical Feasibility Study of the Forensic Psychiatry and Violence Oxford (FoVOx) Tool. Front Psychiatry. 2019;10:901. Published 2019 Dec 13. doi:10.3389/fpsyt.2019.00901

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