Decision Support Hospital Patient Release Example

Important factors are entered. Factors are given an importance rating 1- 10 i.e.
Aggressive behaviour 10
Abnormal behaviour 9
Bad External Support 8
Bad Stress 7
Bad External environment 6
Entrants- Patient names are put into database
Patient A
Patient B
Patient C
Patients are given a rating for each factor 10 being the highest I.e
Patient A factor Aggressive behaviour: 8 - the Patient scored low
Patient A factor Abnormal behaviour: 10 - the Patient scored high
Patient A factor Bad External Support: 10 - the Patient scored high
Patient A factor Bad Stress: 4 - the Patient has no stress
Patient A factor Bad External environment: 2 - the External environment is good
Patient B factor Aggressive behaviour: 2 - the Patient is not threatening
Patient B factor Abnormal behaviour: 10 - the Patient scored high
Patient B factor Bad External Support: 8 - the Patient scored 3st
Patient B factor Bad Stress: 6 - the Patient has low stress
Patient B factor Bad External environment: 8 - the External environment is not good
Patient C factor Aggressive behaviour: 9 - the Patient scored medium
Patient C factor Abnormal behaviour: 10 - the Patient scored high
Patient C factor Bad External Support: 10 - the Patient scored high
Patient C factor Bad Stress: 6 - the Patient has low stress
Patient C factor Bad External environment: 8 - the External environment is not good
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to view the calculated result
note in this example Patient C result is worst candidate for release because they have the highest score over many factors,
Aggressive behaviour is the worst offence Patient C also has a bad external environment which scores highly against release
If the bad external environment was not rated highly important a different Patient may have been less suitable for release

Inducing behavior were used as the criteria.
Note that many factors are not used (e.g., substance use/abuse, medication compliance, family conflict) would likely be relevant in settings other than the hospital.
Given the current state of knowledge in terms of short-term violence risk in mental health settings, It is recommended that clinicians use a combined approach whereby they familiarize themselves with the empirical literature regarding risk factors for violent behavior and structure their inquiry and judgments around these factors.
Use of a structured, guided clinical assessment

e.g., HCR-20 (Webster, Douglas, Eaves,& Hart, 1997;
see Table 1
supplemented by
an anamnestic analysis of the client’s violence history should form the basis of a comprehensive evaluation that assesses factors relevant to violence risk.
Risk Factors for Violence
Broadly speaking, risk factors for violence among persons with mental disorders fall into one of two categories.
Static risk factors are those that either cannot be changed (e.g., age, sex) or are not particularly amenable to change (e.g., psychopathic personality struc- ture). Identification of these factors is important in terms of identifying the client’s abso- lute or relative level of risk; however, these factors typically have few implications for treatment or management of risk since the factors, by definition, cannot be changed.
In contrast, dynamic risk factors are those that are amenable to change (e.g., sub- stance abuse, psychotic symptomatology). Identification of these factors is important
Table 1
HCR 20 Items (Webster et al., 1997)
A. Historical Items
1. Previous violence
2. Young age at first violent incident
3. Relationship instability
4. Employment problems
5. Substance use problems
6. Major mental illness
7. Psychopathy
8. Early maladjustment
9. Personality disorder
10. Prior supervision failure
B. Clinical Items
1. Lack of insight (into mental disorder)
2. Negative attitudes (toward others, institutions, social agencies, the law)
3. Active symptoms of major mental illness
4. Impulsivity
5. Unresponsive to treatment
C. Risk Management Items
1. Plans lack feasibility
2. Exposure to destabilizers (e.g., weapons, substances, potential victims)
3. Lack of personal support
4. Noncompliance with remediation attempts
5. Stress

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