OxMIV Qualitative Acceptability Study
Research type
Research Study
Full title
Use of a violence risk assessment tool (OxMIV) in Early Intervention in Psychosis services: a qualitative study of acceptability to patients and clinicians
IRAS ID
270811
Contact name
Daniel Whiting
Contact email
Sponsor organisation
University of Oxford / Clinical Trials and Research Governance
Duration of Study in the UK
0 years, 11 months, 26 days
Research summary
Summary of Research
Community mental health teams called Early Intervention in Psychosis (EIP) services assess and treat people with the onset of psychotic illnesses like schizophrenia. Although most people with schizophrenia never act violently, developing this type of illness does slightly increase the chances of this, especially if there are other risk factors such as previous violence or drug use.
One thing EIP services must assess therefore is whether an individual might behave violently in the future. This can help guide what input they might need. Making this assessment evidence-based, consistent and efficient is difficult though, particularly when there are many other needs to assess. Clinicians in EIP services have varying experience in assessing violence risk, and currently have no practical methods to standardise and support this assessment.
A simple tool for assessing risk of violence in mental illness is however now available, called OxMIV (Oxford Mental Illness and Violence). Its accuracy was validated using large Swedish population databases. Importantly it is free and quick to use, so might support clinical practice in EIP services.
To be valuable in a clinical setting, a prediction tool needs to not only be accurate, but be practically helpful. This includes being convenient, trusted and having a clear role that is accepted by clinicians. It also needs to be acceptable to patients and carers. Without these qualities, even a very accurate tool will have no positive impact on clinical practice or patient outcomes.
This study will therefore explore these issues for OxMIV. To understand in depth different views about risk assessment, assessment tools, and specific experiences of the use of OxMIV, individual interviews will be conducted with clinicians, patients and carers in EIP services with access to the tool. The understanding that emerges will help guide how the tool could best help EIP services assess violence risk.
Summary of Result
Whilst most people presenting to mental health services never behave violently, for a minority this is something that they might need help with as part of their treatment and support. This includes some people with the new onset of symptoms of psychosis, who are supported by specialist services called early intervention services. Whether this is a relevant need for someone is already routinely assessed. Current clinical approaches and challenges to this assessment process have not previously been described in detail however.
One way that other areas of medicine approach such assessments is the use of simple prediction tools. These are clinical aids that weigh up information about different factors that increase the risk of a particular adverse outcome, in this case violence, to estimate the overall chances of this happening. "OxMIV" is a simple risk prediction tool for violence that might be helpful in early intervention services. Whether this approach is feasible and acceptable, and what its clinical role would be, has yet to be examined. This study therefore used qualitative interviews with patients, carers and clinicians to understand current approaches and attitudes to violence risk assessment in these services, clinicians’ preconceptions and expectations about the use of a structured violence risk assessment tool, and perspectives of the OxMIV tool.
Twelve patients and carers and 21 clinicians were interviewed. Key challenges of current practice were highlighted to be around low clinician confidence, subjectivity of assessments, the description and communication of risk, and a wariness around broaching the topic of violence from clinicians for fear of reinforcing stigma. Concerns about sensitivity were not held to the same degree by patients and carers, who viewed violence risk as an acceptable consideration, and did not regard the issue of stigma to preclude clinicians considering risk when undertaken as part of a professional interaction. They encouraged a straightforward approach. Carers highlighted the importance of their involvement in this holistic consideration of risk. Key areas for improvement were outlined around training, the framing of violence risk assessment within a clinical interaction, and information-sharing.
With regards the “OxMIV” tool, its use was regarded as both feasible and acceptable by patients, carers and clinicians. Clinicians felt it had potential to improve their confidence, consistency and baseline knowledge, and it refined clinical views rather than changing them. It provided richer information than their current assessment processes whilst only taking a few minutes. Patients and carers suggest that use of the tool might improve the sense that such assessment was routine, which was important to its acceptability. All agreed that the role was a complementary one that should not replace the overall clinical judgement.
The findings move forward understanding of how clinical practice in the assessment of violence risk in these services could be improved. A key are of future focus is how the tool can inform what support is offered, and it was particularly important to patients and carers that it would lead to some positive impact on the care that was subsequently offered should needs be highlighted.
REC name
West Midlands - Solihull Research Ethics Committee
REC reference
20/WM/0011
Date of REC Opinion
17 Feb 2020
REC opinion
Further Information Favourable Opinion