Inpatient risk management with mentally ill offenders: results of a survey on clinical decision-making about easing restrictions.

BACKGROUND Procedures for easing restrictions in forensic hospitals are an important part of treatment and serve to prepare inpatients for community conditions. In spite of this, there are still very few empirical data on the assessment of the risks involved. Clinical experience, expert knowledge and theoretical considerations indicate that the risk factors for recidivism after discharge from hospital are not identical with those that predict incidents during hospitalization or during the easing of restrictions. AIMS To determine both possible risk factors for incidents during hospitalization and criteria allowing easing of regulations and confinement. METHODS A survey was conducted of clinicians in forensic hospitals concerning their perception of risk and protective factors. RESULTS The survey revealed that stable dynamic factors were more relevant for clinicians than static risk factors. Furthermore, clinicians rated protective factors as being as important as risk factors. Depending on the rehabilitation process, aspects of the social network outside the institutions were also rated as being important. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE These findings offer some clarification of the concept of clinical judgment as applied to assessment of readiness for discharge of offender patients from specialist forensic psychiatric hospitals. Research into risk assessment and management might be improved by taking account of explicit clinical concerns.