C S H Brown1, K R Lloyd. 1. Department of Mental Health, University of Exeter, Exeter, UK.
Abstract
OBJECTIVE: To compare the clinical risk assessment of patients by psychiatrists working in different mental health service settings (low, medium and high security). METHOD: Operationalized criteria of clinical factors recognized as indicating risk of harm to others were developed into a simple checklist with explicit item descriptions and definitions (OP-RISK). This was used to compare risk assessments in a prospective cohort of 161 consecutive referrals to a high secure psychiatric hospital. RESULTS: Agreement on the risk posed by a patient between psychiatrists working outside and inside high secure services using unstructured clinical risk assessment was poor (kappa=-0.006). When OP-RISK was applied to the clinical risk assessments, agreement improved (kappa=0.742). CONCLUSION: Applying operationalized criteria to clinical risk assessment is useful in integrating different mental health service settings. The use of OP-RISK may facilitate the referral process to tertiary care.
OBJECTIVE: To compare the clinical risk assessment of patients by psychiatrists working in different mental health service settings (low, medium and high security). METHOD: Operationalized criteria of clinical factors recognized as indicating risk of harm to others were developed into a simple checklist with explicit item descriptions and definitions (OP-RISK). This was used to compare risk assessments in a prospective cohort of 161 consecutive referrals to a high secure psychiatric hospital. RESULTS: Agreement on the risk posed by a patient between psychiatrists working outside and inside high secure services using unstructured clinical risk assessment was poor (kappa=-0.006). When OP-RISK was applied to the clinical risk assessments, agreement improved (kappa=0.742). CONCLUSION: Applying operationalized criteria to clinical risk assessment is useful in integrating different mental health service settings. The use of OP-RISK may facilitate the referral process to tertiary care.