Implementation of risk assessment tools in psychiatric services

Abstract

Violence remains a major risk management concern in psychiatric services with implications on the safety and well-being of patients, staff, and the public. Serious physical and psychological consequences of violence involving property damage, bodily injuries, and threat to life have been reported in mental health services. Risk assessment tools are important safeguard measures; however, research on clinical implementation is presently limited. Structured professional judgment (SPJ) risk management tools that incorporate professional discretion with analytical understanding of evidence-based risk factors are widely accepted for risk assessment. However, clinical utility is suboptimal due to several barriers, including those related to the tool, the clinical setting, and resistance from health professionals. To better understand the challenges militating against optimal implementation of risk assessment tools, we reviewed and presented some lessons from the implementation of clinical practice guidelines on a general scale and our experience implementing an SPJ tool called Hamilton Anatomy of Risk Management across a variety of psychiatric services. In summary, the clinical utility of risk assessment tools improves if the tool is psychometrically sound, concise, consensus rated, time efficient, and practical for planning risk management. User feedbacks on the tool utility are also important to sustain implementation.

Keywords: implementation; risk assessment tools; structured professional judgments tools; violence.