Therapeutic Risk Management for Violence: Safety Planning for Other-directed Violence

Crisis plans in mental health: A scoping review

Crisis situations are frequent among people with mental health disorders. Several interventions have been developed to act in prevention, including crisis plans recognized as particularly effective in reducing coercive measures. In the literature, several models of crisis plans are proposed with similar aims and contents. Based on the methodology proposed by the Joanna Briggs Institute, a scoping review was conducted to map the state of knowledge on crisis plans in adult mental health settings. The literature search conducted on six databases (CINAHL, PubMed, Medline, EMBASE, PsychINFO and Cochrane) yielded 2435 articles. Of these, 122 full-text articles were assessed for eligibility, and 78 met the inclusion criteria. Studies were critically appraised using the Joanna Briggs Institute appraisal tools, and data were extracted by two independent reviewers. Content analysis identified a typology of crisis plans: (1) the legal crisis plan and (2) the formal crisis plan. Five modalities were identified for its completion: the sections, the moment, the completion steps, the people involved and the training of key actors. Most identified outcomes are consistent with the main purpose of the intervention, which is crisis prevention. However, the most identified outcomes focused on the service user's recovery and indicated that crisis plans could provide an opportunity to operationalize recovery in mental healthcare, thus suggesting an evolution in the aim of the intervention. Future research should further focus on the modalities of crisis plans to guide the implementation in clinical practice.

The Role of Situational Factors in Child-to-Parent Abuse: Implications for Assessment, Management, and Intervention

Situational factors are relevant to the initiation and maintenance of violent behavior yet are infrequently examined in relation to family violence. Content analysis was used to conduct an inductive thematic analysis of police narratives to identify and quantify the occurrence of situational factors among Australian young people (10-24 years) reported to police for using violence toward a parent (n = 82). Descriptive information about demographics (e.g., age and sex), background characteristics (e.g., victimization history, employment/school issues, mental health issues, and neurodevelopmental conditions), and features of the index incident (e.g., type of aggression) were also extracted from police records. Interpersonal conflict and parental limit-setting were the most common situational antecedents of child-to-parent abuse, with additional situational factors including use of weapons, role of third parties, mental health concerns, and substance abuse issues. Families experiencing child-to-parent abuse showed heightened levels of intrafamilial violence and neurodevelopmental conditions. Implications for risk assessment, management, and intervention are discussed.

Firearm Injury Prevention and Extreme Risk Protection Orders

Extreme risk protection orders (ERPOs) represent a potential mechanism to facilitate firearm-related lethal means safety. ERPOs are a legal mechanism that enables law enforcement to temporarily remove firearms from, and prevent firearm purchase by, an individual who presents a significant danger to self or others, as determined by a court of law. While few jurisdictions currently allow mental health professionals to initiate ERPO petitions, it nonetheless seems important that clinicians be familiar with ERPOs, as clinicians may still serve an important role in disseminating information and facilitating judicious petitions. However, ERPO laws remain quite new, and the implications for mental health professionals when participating (directly or indirectly) in ERPOs remain unclear. This column introduces readers to ERPOs and offers resources to learn more about how ERPOs work across various jurisdictions.

Therapeutic Risk Management and Firearm-related Lethal Means Safety

Safety planning to reduce suicide or other-directed violence risk involves efforts toward "making the environment safe," including working collaboratively with at-risk patients to encourage voluntary changes in their firearm storage decisions [ie, lethal means safety (LMS) counseling]. This column provides a conceptual framework and real-world evidence to support the delivery of LMS counseling to at-risk patients, as well as guidance on asking about firearm access and making individualized safety recommendations. It also reviews important elements related to documenting LMS discussions and legal considerations related to these conversations.

Practical Steps Towards Identifying and Assisting Victims of Domestic Violence

Domestic violence is prevalent among psychiatric patients; however, utilization of screening, safety, and legal interventions is low among mental health practitioners. In this column, the authors review interventions that can assist with the identification of victims of domestic violence in daily practice and provide an overview of steps that can be taken to aid these victims and reduce the chance of future violence.