Advertisement

Enhancing Protective Factors in the Management of Violence Risk in Long-Term Psychiatric Care

  • Ana Cristina NevesEmail author
  • Michiel de Vries Robbé
  • Arjan van den Nagel
  • Anouk Bohle
  • Agnes Veldhuizen
Chapter

Abstract

There is a growing recognition that a strengths-based approach to the assessment and management of violence risk brings added value to the rehabilitation of patients in forensic mental health settings. Such an approach seems of particular value for forensic psychiatric patients in long-term treatment, whose risk factors have proven difficult to change or eliminate and for whom the best strategy may be to increase or strengthen protective factors that can counterbalance the influence of chronically present risk factors. Given the impact of decisions that are based on an assessment of the risk of violent behavior, such as regarding security levels or release, the quality of violence risk assessment and management strategies is fundamental, not only for patients themselves but also for staff and public safety. Despite research evidence regarding the value of protective factors and best practice guidelines in several countries, few violence risk assessment tools include a focus on protective factors. One exception is the Structured Assessment of Protective Factors for Violence Risk (SAPROF), a tool that specifically focuses on protective factors which contribute to the desistance from violence and that can offer positive guidelines for strengths-based treatment. However, in long-term care, targeting protective factors can be particularly difficult or unrealistic, since patients have less opportunities for community reintegration and the focus in treatment often lies mainly on the patient’s functioning within the inpatient setting. To improve the assessment and management of protective factors for patients in long-term forensic care, an additional manual to the SAPROF was recently developed that focuses specifically on protective factors deemed valuable for intensive care settings: the SAPROF Long-term Care (SAPROF-LC). In this chapter we provide a rationale for the focus on protective factors that are of particular importance for long-term stay patients and demonstrate an overview of the SAPROF-LC, illustrated by several short case examples.

References

  1. 1.
    Drennan G, Alred D. Recovery in forensic mental health settings: From alienation to integration. In: Drennan G, Alred D, editors. Secure recovery – approaches to recovery in forensic mental health settings. London: Routledge; 2012. p. 1–10.Google Scholar
  2. 2.
    Guy LS, Douglas KS, Hart SD. Risk assessment and communication. In: Cutler BL, Zapf PA, editors. Individual and situational influences in criminal and civil contexts. APA handbook of forensic psychology, vol. 1. Washington: American Psychological Association; 2015.Google Scholar
  3. 3.
    Hollin CR. Risk-needs assessment and allocation to offender programmes. In: McGuire J, editor. Offender rehabilitation and treatment: effective programmes and policies to reduce reoffending. London: Wiley; 2002. p. 309–32.Google Scholar
  4. 4.
    Edworthy R, Vollm B. Long-stay in high and medium secure forensic psychiatric care – prevalence, patient characteristics and pathways in England. Eur Psychiatry. 2016;33:S207.  https://doi.org/10.1016/j.eurpsy.2016.01.385.CrossRefGoogle Scholar
  5. 5.
    Lussier P, Verdun-Jones S, Deslauriers-Varin N, Nicholls T, Brink J. Chronic violent patients in an inpatient psychiatric hospital: prevalence, description, and identification. Crim Justice Behav. 2010;37:5–28.  https://doi.org/10.1177/0093854809347738.CrossRefGoogle Scholar
  6. 6.
    Broderick C, Azizian A, Kornbluh R, Warburton K. Prevalence of physical violence in a forensic psychiatric hospital system during 2011–2013: patient assaults, staff assaults, and repeatedly violent patients. CNS Spectr. 2015;20:319–30.  https://doi.org/10.1017/S1092852915000188.CrossRefPubMedGoogle Scholar
  7. 7.
    Hogan NR, Olver ME. Assessing risk for aggression in forensic psychiatric inpatients: an examination of five measures. Law Hum Behav. 2016;40:233–43.  https://doi.org/10.1037/lhb0000179.CrossRefPubMedGoogle Scholar
  8. 8.
    Kelly EL, Subica AM, Fulginiti A, Brekke JS, Novaco RW. A cross-sectional survey of factors related to inpatient assault of staff in a forensic psychiatric hospital. J Adv Nurs. 2014;71:1110–2.  https://doi.org/10.1111/jan.12609.CrossRefPubMedGoogle Scholar
  9. 9.
    Bhui K, Outhwaite J, Adzinku F, Dixon P, Mcgabhann L, Pereira S, Strathdee G. Implementing clinical practice guidelines on the management of imminent violence on two acute psychiatric in-patient units. J Ment Health. 2001;10:559–69.  https://doi.org/10.1080/09638230120041317.CrossRefGoogle Scholar
  10. 10.
    Carlin P, Gudjonsson G, Yates M. Patient satisfaction with services in medium secure units. J Forens Psychiatry Psychol. 2005;16:714–28.  https://doi.org/10.1080/14789940500328245.CrossRefGoogle Scholar
  11. 11.
    Ogloff JRP, Daffern M. The dynamic appraisal of situational aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients. Behav Sci Law. 2006;24:799–813.  https://doi.org/10.1002/bsl.741.CrossRefPubMedGoogle Scholar
  12. 12.
    NICE. NICE guidelines [NG10] - Violence and aggression: short-term management in mental health, health and community settings. London: National Institute for Health and Care Excellence; 2015. Available: https://www.nice.org.uk/guidance/NG10/.Google Scholar
  13. 13.
    Guy LS. Performance indicators of the structured professional judgment approach for assessing risk for violence to others: a meta-analytic survey. Dissertation Simon Fraser University. 2008.Google Scholar
  14. 14.
    Hogan N, Ennis L. Assessing risk for forensic inpatient violence: a meta-analysis. OAJFP. 2010;2:137–47.Google Scholar
  15. 15.
    Yang M, Wong SCP, Coid J. The efficacy of violence prediction: a meta-analytic comparison of nine risk assessment tools. Psychol Bull. 2010;136:740–67.  https://doi.org/10.1037/a0020473.CrossRefPubMedGoogle Scholar
  16. 16.
    Fazel S, Singh JP, Doll H, Grann M. Use of risk assessment instruments to predict violence and antisocial behaviour in 73 samples involving 24,827 people: systematic review and meta-analysis. BMJ. 2012;345:e4692.CrossRefGoogle Scholar
  17. 17.
    de Ruiter C, Nicholls TL. Protective factors in forensic mental health: a new frontier. Int J Forensic Ment Health. 2011;10:160–70.  https://doi.org/10.1080/14999013.2011.600602.CrossRefGoogle Scholar
  18. 18.
    Ward T, Stewart C. Criminogenic needs and human needs: a theoretical model. Psychol Crime Law. 2003;9:125–44.  https://doi.org/10.1080/1068316031000116247.CrossRefGoogle Scholar
  19. 19.
    Lord A. Integrating risk, the Good Lives Model and recovery for mentally disordered sexual offenders. J Sex Aggress. 2014;22:107–22.  https://doi.org/10.1080/13552600.2014.975164.CrossRefGoogle Scholar
  20. 20.
    Van Damme L, Hoeve M, Vermeiren R, Vanderplasschen W, Colins OF. Quality of life in relation to future mental health problems and offending: testing the good lives model among detained girls. Law Hum Behav. 2016;40:285–94.  https://doi.org/10.1037/lhb0000177.CrossRefPubMedGoogle Scholar
  21. 21.
    Wainwright L, Nee C. The Good Lives Model: new directions for preventative practice with children? Psychol Crime Law. 2014;20:166–82.  https://doi.org/10.1080/1068316X.2013.770851.CrossRefGoogle Scholar
  22. 22.
    Stouthamer-Loeber M, Loeber R, Wei E, Farrington DP, Wikstrom PH. Risk and promotive effects in the explanation of persistent serious delinquency in boys. J Consult Clin Psychol. 2002;70:111–23.  https://doi.org/10.1037/0022–006X.70.1.11.CrossRefPubMedGoogle Scholar
  23. 23.
    O’Shea LE, Dickens GL. Contribution of protective factors assessment to risk prediction: Systematic review and meta-analysis. Eur Psychiatry. 2015;30:211.  https://doi.org/10.1016/S0924-9338(15)30171-1.CrossRefGoogle Scholar
  24. 24.
    Sampson RJ, Laub JH. Life-course desisters? Trajectories of crime among delinquent boys followed to age 70. Criminology. 2003;41:301–39.  https://doi.org/10.1111/j.1745-9125.2003.tb00997.x.CrossRefGoogle Scholar
  25. 25.
    Laub JH, Nagin DS, Sampson RJ. Trajectories of change in criminal offending: good marriages and the desistance process. Am Sociol Rev. 1998;63:225–38.  https://doi.org/10.2307/2657324.CrossRefGoogle Scholar
  26. 26.
    Bouman YHA, de Ruiter C, Schene AH. Social ties and short-term self-reported delinquent behaviour of personality disordered forensic outpatients. Legal Criminol Psych Journal. 2010;15:357–72.  https://doi.org/10.1348/135532509X444528.CrossRefGoogle Scholar
  27. 27.
    Jolliffe D, Farrington DP, Loeber R, Pardini D. Protective factors for violence: results from the Pittsburgh Youth Study. J Crim Justice. 2016;45:32–40.  https://doi.org/10.1016/j.jcrimjus.2016.02.007.CrossRefGoogle Scholar
  28. 28.
    Department of Health, National Risk Management Programme. Best practice in managing risk: principles and evidence for best practice in the assessment and management of risk to self and others in mental health services. 2007. Available: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk.
  29. 29.
    Barbaree H, Goering P. Summary report on the evidence-based practices in forensic mental health programs and services project: the development of standards, benchmarks, and performance indicators. 2006. Available: http://www.hsjcc.on.ca
  30. 30.
    Allnutt S, O’Driscoll C, Ogloff JRP, Daffern M, Adams J. Clinical risk assessment & management: a practical manual for mental health clinicians. Sydney: Justice Health; 2010.Google Scholar
  31. 31.
    Almeida JMC, Killaspy H. Long-term mental health care for people with severe mental disorders. Brussels: European Union; 2011. Available: http://ec.europa.eu/.Google Scholar
  32. 32.
    American Psychological Association. APA presidential task force on evidence-based practice. Am Psychol. 2006;61:271–85.  https://doi.org/10.1037/0003-066X.61.4.271.CrossRefGoogle Scholar
  33. 33.
    de Vogel V, de Ruiter C, Bouman Y, de Vries Robbé M. SAPROF: guidelines for the assessment of protective factors for violence risk. English Version. Utrecht: Forum Educatief; 2009.Google Scholar
  34. 34.
    Barnao M, Ward T, Casey S. Taking the good life to the institution: forensic service users’ perceptions of the Good Lives Model. Int J Offender Ther Comp Criminol. 2016;60:766–86.  https://doi.org/10.1177/0306624X15570027.CrossRefPubMedGoogle Scholar
  35. 35.
    Rogers R. The uncritical acceptance of risk assessment in forensic practice. Law Hum Behav. 2000;24:595–605.  https://doi.org/10.1023/A:1005575113507.CrossRefPubMedGoogle Scholar
  36. 36.
    Webster CD, Martin ML, Brink J, Nicholls TL, Desmarais SL. Short-term assessment of risk and treatability (START) (Version 1.1). Coquitlam: British Columbia Mental Health and Addiction Services; 2009.Google Scholar
  37. 37.
    Andrews DA, Bonta J, Wormith SJ. The level of service/case management inventory (LS/CMI). Toronto: Multi-Health Systems; 2004.Google Scholar
  38. 38.
    Webster CD, Douglas KS, Eaves D, Hart SD. HCR-20: Assessing the risk of violence (Version 2). Burnaby: Simon Fraser University and Forensic Psychiatric Services Commission of British Columbia; 1997.Google Scholar
  39. 39.
    Douglas KS, Hart SD, Webster CD, Belfrage H. HCR-20V3: Assessing risk of violence – user guide. Burnaby: Mental Health, Law, and Policy Institute, Simon Fraser University; 2013.Google Scholar
  40. 40.
    de Vries Robbé M, Geers MCK, Stapel M, Hilterman ELB, de Vogel V. SAPROF – youth version: guidelines for the assessment of protective factors for violence risk in juveniles (English version). Utrecht: Van der Hoeven Kliniek; 2015.Google Scholar
  41. 41.
    Abidin Z, Davoren M, Naughton L, Gibbons O, Nulty A, Kennedy H. Susceptibility (risk and protective) factors for in-patient violence and self-harm: prospective study of structured professional judgment instruments START and SAPROF, DUNDRUM-3 and DUNDRUM-4 in forensic mental health services. BMC Psychiatry. 2013;13:197–215.  https://doi.org/10.1186/1471-244X-13-197.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Persson M, Belfrage H, Fredriksson B, Kristiansson M. Violence during imprisonment, forensic psychiatric care, and probation: correlations and predictive validity of the risk assessment instruments COVR, LSI-R, HCR-20V3, and SAPROF. Int J Forensic Ment Health. 2017;16:117–29.  https://doi.org/10.1080/14999013.2016.1266420.CrossRefGoogle Scholar
  43. 43.
    Davoren M, Abidin Z, Naughton L, Gibbons O, Nulty A, Wright B, Kennedy HG. Prospective study of factors influencing conditional discharge from a forensic hospital: the DUNDRUM-3 programme completion and DUNDRUM-4 recovery structured professional judgment instruments and risk. BMC Psychiatry. 2013;13:185–201.  https://doi.org/10.1186/1471-244X-13-185.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    de Vries Robbé M. Protective factors: validation of the structured assessment of protective factors for violence risk in forensic psychiatry. Utrecht: Van der Hoeven Kliniek; 2014.. Available: www.saprof.comGoogle Scholar
  45. 45.
    Yoon D, Spehr A, Briken P. Structured assessment of protective factors: a German pilot study in sex offenders. J Forens Psychiatry Psychol. 2011;22:834–44.  https://doi.org/10.1080/14789949.2011.617831.CrossRefGoogle Scholar
  46. 46.
    Zeng G, Chu CM, Lee Y. Assessing protective factors of youth who sexually offended in Singapore: preliminary evidence on the utility of the DASH-13 and the SAPROF. Sex Abus. 2015;27:91–108.  https://doi.org/10.1177/1079063214561684.CrossRefGoogle Scholar
  47. 47.
    Viljoen S, Nicholls TL, Roesch R, Gagnon N, Douglas K, Brink J. Exploring gender differences in the utility of strength-based risk assessment measures. Int J Forensic Ment Health. 2016;15:149–63. https://doi.org/10.1080/14999013.2016.1170739.
  48. 48.
    Andrews DA, Bonta J. The psychology of criminal conduct. 5th ed. Cincinnati: Anderson Publishing Co; 2010.Google Scholar
  49. 49.
    Abbiati M, Azzola A, Palix J, Gasser J, Moulin V. Validity and predictive accuracy of the structured assessment of protective factors for violence risk in criminal forensic evaluations: a Swiss cross-validation retrospective study. Crim Justice Behav. 2017;44:493–510.  https://doi.org/10.1177/0093854816677565.CrossRefGoogle Scholar
  50. 50.
    de Vries Robbé M, de Vogel V, Wever EC, Douglas KS, Nijman HLI. Risk and protective factors for inpatient aggression. Crim Justice Behav. 2016;43:1364–85.  https://doi.org/10.1177/0093854816637889.CrossRefGoogle Scholar
  51. 51.
    de Vries Robbé M, van den Nagel A, Bohle A, Veldhuizen A. SAPROF long-term care: additional guidelines for the assessment of protective factors for violence risk in intensive (forensic) psychiatry care. Utrecht, The Netherlands; 2017.Google Scholar
  52. 52.
    Simpson AIF, Penney SR. The recovery paradigm in forensic mental health services. Crim Behav Ment Health. 2011;21:299–306.  https://doi.org/10.1002/cbm.823.CrossRefPubMedGoogle Scholar
  53. 53.
    Reeve S, Sheaves B, Freeman D. The role of sleep dysfunction in the occurrence of delusions and hallucinations: a systematic review. Clin Psychol Rev. 2015;42:96–115.  https://doi.org/10.1016/j.cpr.2015.09.001.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Krizan Z, Herlache AD. Sleep disruption and aggression: implications for violence and its prevention. Psychol Violence. 2015;  https://doi.org/10.1037/vio0000018.
  55. 55.
    Diener E, Chan MY. Happy people live longer: subjective well-being contributes to health and longevity. Appl Psychol Health Well Being. 2011;3:1–43.  https://doi.org/10.1111/j.1758-0854.2010.01045.x.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ana Cristina Neves
    • 1
    • 2
    Email author
  • Michiel de Vries Robbé
    • 3
  • Arjan van den Nagel
    • 4
  • Anouk Bohle
    • 4
  • Agnes Veldhuizen
    • 4
  1. 1.Centro de Investigação Interdisciplinar Egas Moniz (CiiEM)Instituto Universitário Egas MonizMonte de CaparicaPortugal
  2. 2.Dvision of Control and Technical SupervisionDirectorate-General of Reintegration and Prison Services (DGRSP)LisbonPortugal
  3. 3.Child and Adolescent PsychiatryVU University Medical CenterAmsterdamThe Netherlands
  4. 4.Van der Hoeven KliniekUtrechtThe Netherlands

Personalised recommendations