Needs and risks of patients in a state-wide inpatient forensic mental health population.

Routine needs assessments have become mandated requirements for public mental health services. However, the appropriateness of these generic health needs assessments to specialist populations remains questionable. This study sought to assess individual needs assessed using a widely used clinician rated assessment (Health of the Nation Outcome Scales-Secure; HoNOS-Secure), a subjective needs assessment that considers both staff and patient perspectives (Camberwell Assessment of Need-Forensic version; CANFOR), and a measure of risk for general criminal recidivism (Level of Service Inventory: Screening Version; LSI:SV) in a secure forensic mental health service. Results revealed significant positive correlations between staff ratings on HoNOS-Secure, CANFOR total needs, and CANFOR met needs scores, but no significant association between CANFOR ratings or HoNOS-Secure ratings and LSI:SV scores. Although patients and staff reported the same number of needs overall according to CANFOR (7.2 vs. 7.5, P > 0.05), patients reported that more of these needs were unmet (3.1 vs. 2.3, P < 0.05). Differences between staff and patient ratings of need suggest that needs assessments should include patient perspectives to facilitate more collaborative and comprehensive care planning. Divergent perspectives between patients and staff may impair patient engagement in treatment and therefore negatively impact on outcome. Service planning issues and opportunities for future research are discussed.

The impact of psychiatric symptoms, interpersonal style, and coercion on aggression and self-harm during psychiatric hospitalization.

Interpersonal style, a key component of personality and personality disorder, has emerged as an important characteristic that is relevant to aggressive behavior by patients in psychiatric hospitals. However, studies examining the relationship between interpersonal style and aggression have thus far only been conducted with patients with personality disorder and/or mild and stable symptoms of mental illness. This study explored the relative importance of patients' interpersonal style, psychiatric symptoms, and perceptions of staff coercion on aggression and self-harm during acute psychiatric hospitalization. One hundred and fifty-two patients (M = 38.32 years, SD = 12.06; 56.8% males and 43.2% females) admitted for short-term assessment and treatment to the acute units of a civil and a forensic psychiatric hospital were administered the Brief Psychiatric Rating Scale, Impact Message Inventory, and MacArthur Admission Experience Survey. Participants' files were reviewed and nursing staff were interviewed at the end of each patient's hospital stay to determine whether participants had self-harmed or acted aggressively towards others. Initial univariate analyses showed that thought disorder and dominant and hostile-dominant interpersonal styles predicted aggression. Using multiple regression and controlling for gender and age, only a hostile-dominant interpersonal style predicted aggression (ß = .258, p < .05). No factors were significantly related to self-harm. These results suggest that measures of interpersonal style are sensitive to those aspects of interpersonal functioning that are critical to patient's responses to the demands of psychiatric in-patient treatment. Procedures to assess risk and engage and manage potentially aggressive patients, including limit-setting styles and de-escalation strategies, should take into account the interpersonal style of patients and the interpersonal behavior of staff.

Factors associated with seclusion in a statewide forensic psychiatric service in Australia over a 2-year period.

Despite seclusion being described as one of the most ethically- and legally-controversial management options available, it remains a widely-used clinical strategy for managing disruptive, aggressive, and violent behaviour. This study sought to determine how frequently seclusion was used, the common characteristics of those secluded and not secluded, and the degree to which the Level of Service Inventory - Revised: Screening Version (LSI-R: SV) could predict seclusion. The study was retrospective, covering the first 2 years of operation of a statewide forensic psychiatry hospital in Victoria, Australia. Data were collected from individual case files, electronic databases, and paper copies of records pertaining to violent incidents and episodes of seclusion. Eighty five (44%) of the 193 patients admitted during this period were secluded. Those secluded were significantly younger and had a more established psychiatric history. LSI-R: SV scores were significantly and positively associated with being secluded. A statistical model containing three LSI-R: SV items, along with age on admission and psychiatric history, achieved an area under the curve of 0.74. Seclusion is used on a regular basis in response to a range of different forms of aggressive behaviour of different severity. The LSI-R: SV demonstrated moderate-to-good accuracy in predicting seclusion and warrants further research using detailed prospective methodologies.