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Can we track and predict when – and which – forensic psychiatric patients are likely to become violent, to help protect both patients and staff from acts of violence?


To examine links between critical incidents (such as violence, damage to property, absconding, and self-harm) and routinely assessed risk factors for violence in forensic psychiatry inpatients.

Why is this important?

Forensic psychiatry patients are some of the most disturbed and difficult to manage patients.

They usually have severe mental illnesses which need to be treated in the context of a criminal offence, making them a risk to themselves and the public.

They are usually placed in secure hospitals (also called high, medium, and low secure units) where a variety of mental health specialists work together to manage their care.

This care costs around four times more than caring for other types of psychiatric patients. In part due to the high rates of violent incidents to staff and other patients in these units.

Being able to track or predict when and which patients are likely to become violent could help protect both patients and staff from acts of violence as well cut costs.


This study will test an online questionnaire, known as Foxweb. Foxweb was developed to collect routine information on risk factors for violence for psychiatric inpatients in Oxford Health NHS trust

Risk factors may include, for example, alcohol or drug use, greater impulsivity, non-adherence with medication and therapy, and so on.

The Foxweb questionnaire asks members of staff to rate an individual’s risk factors on a scale of zero to five. Staff will complete these every 1-2 weeks.

The data from Foxweb will then be compared with records of any critical/serious incidents. This will be used to see if Foxweb can reliably and accurately assess and monitor the risk of violence in these patients. 

How this could benefit patients

Finding a practical, reliable and accurate way of assessing and monitoring the risk of violence in these patients will help the staff who care for them to identify when someone is likely to become violent.

This could allow carers to take the appropriate means to intervene before an incident occurs, not only potentially improving the health of the monitored patient, but also other patients and staff who could be victims of any violence.

Additional benefits may be the form of cost-savings to the NHS, achieved through reductions in clinical time and possible reductions in critical incidents in inpatient units.

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