Malpractice claims in psychiatry: approaches to reducing risk

Abstract

World Psychiatry 20:3 October 2021 tools with high negative predictive values can usefully screen out low-risk persons to preserve resources. But evidence-based risk assessment will only improve outcomes if linked to interventions, and effective ones. A key uncertainty is whether treating symptoms of mental illness will prevent victimization outcomes. There is some evidence suggesting that depressive symptoms may be predictive of victimization, but this work needs replication. Research on specific interventions aiming to reduce victimization risk in persons with mental disorders remains rare, because victimization has traditionally been viewed as a risk factor rather than a consequence of mental illness. One significant change would be to consider including victimization as an outcome in mental health treatment trials, particularly those that follow up people beyond a few weeks. Improving access to treatment for comorbid substance misuse is an important policy consideration, as research has clearly demonstrated that this comorbidity explains a large share of the elevated victimization risk in persons with mental illness. More contact with friends and family members may act as a protective factor against victimization risk, and supporting measures to promote this can be enhanced across all mental health services. However, it is important to make sure that such interactions do not actually lead to increased exposure to criminogenic environments. Finally, large-scale clinical and genetically informed studies, preferably linked with registry data and electronic health records, may clarify specific etiological mechanisms involved, leading to trials of interventions targeting these mechanisms.