Valuing patients' self-perceptions of risk, to prevent community violence

Comparing the predictive utility of patients’ own perceptions of risk, compared to mental health professionals and risk assessment technology.  Consider asking the person who knows best!

People with mental illness are sometimes hospitalized to protect themselves or others from harm.  Although risk assessment instruments could help identify people who can safely live in the community, these instruments are rarely used in clinical settings because they require hours to complete and divert scarce resources from treatment.

In partnership with patients and hospitals in Orange County, we identified an innovative and clinically feasible method for assessing patients’ risk. Our model shifts focus from clinical prediction to patients’ self-prediction, given that patients have a lifetime of experience in a wide variety of situations. We find that patients predict their own involvement in self harm and violence as accurately as risk assessment tools — and better than clinicians. Self prediction holds considerable promise as a feasible method for partnering with patients in efforts to prevent violence and improve healthy outcomes.

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