Building mental health professionals' decisional models into tests of predictive validity: The accuracy of contextualized predictions of violence

To safely manage potentially violent patients in the community, mental heal th professionals (MHPs) must assess when and under what conditions a patien t may be involved in a violent act. This study applies a more ecologically sensitive approach than past research by building the conditions that MHPs believe make patient violence more likely into tests of their predictive va lidity. In specific, the accuracy of MHPs' predictions that patients were m ore likely to become violent when they consumed alcohol was assessed based on a sample of 714 patients. The results indicate that MHPs do not discrimi nate based on a sample of 714 patients. The results indicate that MHPs do n ot discriminate well between patients who are likely to become violent duri ng periods in which they drink from those who are not. MHPs' predictions ap pear more descriptive of the drinking behaviour of a high-risk group than p redictive of alcohol-related violent incidents. Thus, even when their appar ent decisional processes are considered in tests of accuracy, MHPs' predict ions of violence are only moderately more accurate than chance. This paper analyses the implications of these findings for risk assessment practice an d for conducting further clinically relevant research.