What are some practical guidelines that clinicians should follow when documenting that they have assessed a patient’s violence risk?

Mental health clinicians frequently evaluate potentially violent patients in a wide variety of settings. For good patient care and to minimize liability risks, those clinicians should consider documenting their patient’s static and dynamic risk factors for violence.  Static risk factors include such items as a person’s age, gender, and history of violence. Although these factors may inform the clinician’s judgment as to their patient’s degree of violence risk, static factors are not subject to change by intervention. In contrast, dynamic factors are subject to change with intervention and include such factors as access to weapons, acute psychotic or mood symptoms, active substance use, recent stressors, and the person’s living situation. Clinicians may find it helpful write a note that outlines the following: 1. identified violence risk factors; 2. management and treatment strategies to address dynamic risk factors; 3. the current status of each dynamic risk factor; 4. records reviewed;  5. collateral interviews;  6. any consultations conducted; and 7. treatment referrals. This approach will assist in the development of a violence prevention plan.  The clinician should document their reasoning as to how they considered the unique combination of risk factors for their patient and how they organized interventions to manage those risks. In general practice, these areas of documentation are often done in summary fashion, but evidence of appropriate fact gathering and a reasoned judgment is helpful both in patient care and for any retrospective review of whether what was done was clinically sound.

 

REFERENCE

Scott CL and Resnick PJ: Clinical assessment of aggression and violence. In Principles and Practice of Forensic Psychiatry, Third Edition (Editors: Rosner R and Scott CL); CRC Press, Taylor & Francis Group, New York, 2017, pp 623-632.

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