National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland.
BMC Psychiatry. 2013 Jul 9;13:185. doi: 10.1186/1471-244X-13-185.
We set out to examine whether structured professional judgement instruments DUNDRUM-3 programme completion (D-3) and DUNDRUM-4 recovery (D-4) scales along with measures of risk, mental state and global function could distinguish between those forensic patients detained in a secure forensic hospital (not guilty by reason of insanity or unfit to stand trial) who were subsequently discharged by a mental health review board. We also examined the interaction between these measures and risk, need for therapeutic security and eventual conditional discharge.
A naturalistic observational cohort study was carried out for 56 patients newly eligible for conditional discharge. Patients were rated using the D-3, D-4 and other scales including HCR-20, S-RAMM, START, SAPROF, PANSS and GAF and then observed over a period of twenty three months during which they were considered for conditional discharge by an independent Mental Health Review Board.
The D-3 distinguished which patients were subsequently discharged by the Mental Health Review board (AUC = 0.902, p < 0.001) as did the D-4 (AUC = 0.848, p < 0.001). Item to outcome analysis showed each item of the D-3 and D-4 scales performed significantly better than random. The HCR-20 also distinguished those later discharged (AUC = 0.838, p < 0.001) as did the S-RAMM, START, SAPROF, PANSS and GAF. The D-3 and D-4 scores remained significantly lower (better) for those discharged even when corrected for the HCR-20 total score. Item to outcome analyses and logistic regression analysis showed that the strongest antecedents of discharge were the GAF and the DUNDRUM-3 programme completion scores.
Structured professional judgement instruments should improve the quality, consistency and transparency of clinical recommendations and decision making at mental health review boards. Further research is required to determine whether the DUNDRUM-3 programme completion and DUNDRUM-4 recovery instruments predict those who are or are not recalled or re-offend after conditional discharge.
我们旨在研究结构化专业判断工具 DUNDRUM-3 计划完成 (D-3) 和 DUNDRUM-4 恢复 (D-4) 量表，以及风险、精神状态和整体功能测量是否能够区分那些因精神错乱或不适宜受审而被安全法医医院拘留的法医患者，这些患者随后被心理健康审查委员会释放。我们还研究了这些措施与风险、治疗安全需求和最终有条件释放之间的相互作用。
对 56 名新符合有条件释放条件的患者进行了自然观察队列研究。使用 D-3、D-4 和其他量表对患者进行评估，包括 HCR-20、S-RAMM、START、SAPROF、PANSS 和 GAF，然后在 23 个月的时间内对他们进行观察，在此期间，他们由独立的心理健康审查委员会考虑有条件释放。
D-3 区分了哪些患者随后被心理健康审查委员会释放（AUC = 0.902，p < 0.001），D-4 也是如此（AUC = 0.848，p < 0.001）。项目与结果分析表明，D-3 和 D-4 量表的每个项目的表现都明显优于随机。HCR-20 也区分了那些后来被释放的患者（AUC = 0.838，p < 0.001），S-RAMM、START、SAPROF、PANSS 和 GAF 也是如此。即使对 HCR-20 总分进行了校正，D-3 和 D-4 的得分仍然显著较低（更好），表明这些患者被释放。项目与结果分析和逻辑回归分析表明，释放的最强前提是 GAF 和 DUNDRUM-3 计划完成分数。
结构化专业判断工具应提高心理健康审查委员会临床建议和决策的质量、一致性和透明度。需要进一步研究以确定 DUNDRUM-3 计划完成和 DUNDRUM-4 恢复工具是否可以预测那些在有条件释放后被召回或再次犯罪的人。
