Citation

Troquete NA, van den Brink RH, Beintema H, Mulder T, van Os TW, Schoevers RA, Wiersma D. Br. J. Psychiatry 2013; 202(5): 365-371.

Affiliation

MSc, Rob H. S. van den Brink, PhD, Rob Giel Research Center, University Medical Center Groningen; Harry Beintema, MD, Mental Health Organisation Lentis and Forensic Psychiatric Clinic dr S. van Mesdag, Groningen; Tamara Mulder, MD, Mental Health Organisations Drenthe, Assen; Titus W. D. P. van Os, MD, PhD, Mental Health Organisations Friesland, Leeuwarden; Robert A. Schoevers, MD, PhD, Durk Wiersma, PhD, Rob Giel Research Center, University Medical Center Groningen, The Netherlands.

Copyright

(Copyright © 2013, Royal College of Psychiatry)

DOI

10.1192/bjp.bp.112.113043

PMID

23520222

Abstract

BACKGROUND: Forensic psychiatry aims to reduce recidivism and makes use of risk assessment tools to achieve this goal. Various studies have reported on the predictive qualities of these instruments, but it remains unclear whether their use is associated with actual prevention of recidivism in clinical care. AIMS: To test whether an intervention combining risk assessment and shared care planning is associated with a reduction in violent and criminal behaviour. METHOD: A cluster randomised controlled trial (Netherlands Trial Register number NTR1042) was conducted in three out-patient forensic psychiatric clinics. The intervention comprised risk assessment with the Short Term Assessment of Risk and Treatability (START) and a shared care planning protocol formulated according to shared decision-making principles. The control group received usual care. The outcome consisted of the proportion of clients with violent or criminal incidents at follow-up. RESULTS: In total 58 case managers and 632 of their clients were included. In the intervention group (n = 310), 65% received the intervention at least once. Findings showed a general treatment effect (22% of clients with an incident at baseline v. 15% at follow-up, P<0.01) but no significant difference between the two treatment conditions (odds ratio (OR) = 1.46, 95% CI 0.89-2.44, P = 0.15). CONCLUSIONS: Although risk assessment is common practice in forensic psychiatry, our results indicate that the primary goal of preventing recidivism was not reached through risk assessment embedded in shared decision-making.

Language: en