Most violence risk assessment scales were originally developed for use in forensic settings at the time of discharge or release of patients into the community after long-term treatment. However, there is a considerable need for specialized, brief and structured risk assessment tools to inform risk decisions in short-term psychiatric treatment. The present study reports on research findings from the development and implementation of the violence risk screening-10 (V-RISK-10) in two acute psychiatric settings in Norway. The 10-item screen is easy to use, time-saving and may be used for screening of violence risk during hospital stay and after discharge into the community. Prospective validation studies of the screen concerning inpatient and post-release community violence have been conducted. Although data analyses are not yet complete, preliminary findings indicate that the screen has good predictive validity. This suggests that the screen is a promising tool in short-term acute psychiatric settings. However, the importance of reliability in mental health data and tests is well recognized, and a screen with good predictive validity is not worth much if clinicians are unable to agree on the scoring of one and the same patient. In this article we report results from a naturalistic interrater reliability investigation that involved 25 mental health professionals and 73 acute psychiatric patients. V-RISK-10 scoring was accomplished by two raters for each patient. The interrater reliability value for total scores was acceptable. Variations pertaining to the individual V-RISK-10 item, patient characteristics and rater characteristics are discussed.

Background: In acute psychiatry, seclusion has traditionally been used to manage people at risk of harming themselves or others. However, being secluded can be traumatising and cause harm to service users and staff. In North America, sensory modulation strategies and a focus on early identification of aggression warning signs and tailored responses have significantly improved care and reduced seclusion use.

Methods: A six-month pilot of the use of sensory modulation strategies and a brief sensory and risk assessment tool (Safety Tool) was implemented on a 30-bed acute psychiatric unit. Indicators of the impact on seclusion use were audited from service users’ files with feedback collected from clinical staff.

Results: Safety Tools for 43 psychiatric intensive care service users were audited. They required significantly longer hospitalisation (mean=39.4 days) than was the average for the unit (mean=19.0 days). Whereas 65% had been previously secluded, only 26% were secluded after completing a Safety Tool. Most staff had completed or read a Safety Tool with 76% saying it should become part of standard care.

Conclusion: Findings support the significant role that sensory assessment and engagement can play in improving service user care in acute psychiatry.

The diagnostic process after referral to an acute psychiatric treatment facility consists of more than the clinical investigation and laboratory tests. Psychometric tests in a broad range of languages may be such an augmentation of our diagnostic armamentarium, especially for immigrants for whom oral understanding of a dialogue may be restricted. The aim of this study was to discover whether such tests are in use, and how they are distributed among different patient categories. All referrals in one calendar year (N = 1168), as they are depicted in the hospital computerized medical records, were investigated. Fifty-six (6.1%) out of 926 ethnic Norwegians and six (3.0%) out of 198 non-Western immigrants were tested, whereas none of the 44 Western immigrants were. The difference between ethnic Norwegians and the immigrants was significant (Z = −3.05 and p = 0.002). Psychometric tests were thus almost not in use, and even less so in immigrants.

The mean number of resident days was higher among those tested, 11.7 (SD = 11.2), versus those not tested, 7.4 (SD = 10.4) days (t = 2.97 and p = 0.004). Among those tested, length of stay was not significantly different; 11.4 and 11.7 days respectively. The patients tested were older than those not tested. Mean age was 43.0 (SD = 14.4) versus 38.8 (SD = 12.1), with t = 2.65 and p = 0.03. Ethnic Norwegians had the longest mean stay, followed by Western immigrants and non-Western immigrants. The difference in resident days between all immigrants and ethnic Norwegians was significant with Z  =  −2.232 and p = 0.026. There was no such difference between Western and non-Western immigrants: Z = −0.057 and p = 0.95. The level of testing was higher in ethnic Norwegians, and the tested patients stayed longer, maybe indicating more time for testing. Whether this low test activity influences treatment quality is an unsettled question.

Persons with mental diseases are admitted to acute care psychiatric units during the day and night. The distribution of diagnoses given to these patients according to time of day has not previously been studied. All referrals during one year to a 27-bed facility were studied using the computerized medical records. 998 patients were referred during the year, of whom 480 were female. 47% arrived within office hours, 41% in the evening and 12% during the night. In order of frequency, patients with psychotic disorders comprised 26%, narrowly followed by the affective disorders (25%), substance abuse disorders (17%), then personality disorders (13%) and crises and anxiety disorders (12%). There is a tendency towards patients with lower diagnostic ICD-numbers (especially psychotic and affective diagnoses) arriving earlier than the other diagnostic groups. The diurnal variations in diagnoses were otherwise small.

Women with personality disorders were almost thrice as frequent as males, whereas males with substance abuse were almost twice as frequent as females. Patients above 60 years of age with non-abuse related organic disorders were mainly males (26 versus 7).

Patients > 60 years of age (N = 57) had the following frequencies of admission through the 24 hour period: 54.4%, 36.8% and 8.8% (office hours, evening, night), whereas patients below 60 years of age (N = 941) had 46.7%, 41.0% and 12.3%, respectively.