Early Intervention in the Real World
Managing risks of violence in a youth mental health service: a service model description
Article first published online: 28 JUN 2012
© 2012 Wiley Publishing Asia Pty Ltd
Early Intervention in Psychiatry
Volume 6, Issue 4, pages 469–475, November 2012
How to Cite
Purcell, R., Fraser, R., Greenwood-Smith, C., Baksheev, G. N., McCarthy, J., Reid, D., Lemphers, A. and Sullivan, D. H. (2012), Managing risks of violence in a youth mental health service: a service model description. Early Intervention in Psychiatry, 6: 469–475. doi: 10.1111/j.1751-7893.2012.00372.x
- Issue published online: 29 OCT 2012
- Article first published online: 28 JUN 2012
- Received 21 December 2011; accepted 3 March 2012
- first-episode psychosis;
Aim: There is a significant relationship between experiencing a severe mental illness, particularly psychosis, and exhibiting violent or offending behaviour. Reducing, if not preventing, the risks of violence among patients of mental health services is clinically warranted, but models to address this are limited.
Methods: We provide a rationale for, and service description of, a pilot forensic satellite clinic embedded within an early intervention service for patients with emerging psychosis, mood disorder and/or personality disorders. The core elements of the programme and its implementation are described, and demographic, clinical and risk data are presented for the patients assessed during the clinic's pilot phase.
Results: A total of 54 patients were referred, 45 of whom were subsequently assessed via primary or secondary consultation. The majority of patients were male, with psychosis (40%) or major depressive disorder (31%) as the most common diagnoses. Illicit substance use in the sample was common, as was previous aggression (81%) and prior criminal offences (51%). Most referrals related to assessing and managing violent behaviour (64%) and violent/homicidal ideation (38%). On the basis of the risk assessments, 71% of patients were rated as medium to high risk of offending.
Conclusion: Assessing and managing risks of violent offending among young patients are both clinically indicated for a proportion of patients and feasible via a forensic outreach model. Given the proliferation of early psychosis services worldwide, the issue of managing, and ideally preventing, patient risk of violence will almost certainly have wide application. However, a comprehensive evaluation of this model is required to ultimately determine the effectiveness of this approach for improving patient outcomes.