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The relationship between risk and insight in a high-security forensic setting.

P Woods1, V Reed, M Collins

  • 1Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK. Philip.Woods@kcl.ac.uk

Journal of Psychiatric and Mental Health Nursing
|September 6, 2003
PubMed
Summary

Clients with poor insight into their mental health or behavior may pose a higher risk. The Behavioural Status Index (BSI) was used to assess risk and insight in forensic mental health patients.

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Forensic Mental Health

Background:

  • Practitioners in mental healthcare often observe a correlation between poor client insight and increased risk to self or others.
  • Assessing insight and risk is crucial for managing mental health patients, particularly in forensic settings.

Purpose of the Study:

  • To investigate the relationship between risk and insight using the Behavioural Status Index (BSI).
  • To evaluate the validity and clinical utility of the BSI in forensic mental healthcare settings.

Main Methods:

  • Data were collected via a repeated measures method by primary nurses from 503 patients in two high-security mental health hospitals.
  • Factor analysis was employed to identify underlying factors within the BSI, with a specific focus on the insight subscale.

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  • Statistical comparisons were made between independent groups to identify significant differences across factors.

    • Main Results:

    • Factor analysis revealed seven distinct factors, with the first factor encompassing all insight-related items.
    • Significant differences were observed across various factors between independent patient groups.
    • Patients on lower dependency wards and male patients generally scored more normatively on the BSI factors, supporting instrument validity.

    Conclusions:

    • The study provides empirical support for the Behavioural Status Index (BSI) in assessing risk and insight in forensic mental health populations.
    • Findings suggest that BSI scores may be influenced by ward dependency levels and patient gender.
    • The results have implications for clinical practice, treatment planning, and ongoing European research utilizing the BSI.