Enhancing Protective Factors in the Management of Violence Risk in Long-Term Psychiatric Care

There is a growing recognition that a strengths-based approach to the assessment and management of violence risk brings added value to the rehabilitation of patients in forensic mental health settings. Such an approach seems of particular value for forensic psychiatric patients in long-term treatment, whose risk factors have proven difficult to change or eliminate and for whom the best strategy may be to increase or strengthen protective factors that can counterbalance the influence of chronically present risk factors. Given the impact of decisions that are based on an assessment of the risk of violent behavior, such as regarding security levels or release, the quality of violence risk assessment and management strategies is fundamental, not only for patients themselves but also for staff and public safety. Despite research evidence regarding the value of protective factors and best practice guidelines in several countries, few violence risk assessment tools include a focus on protective factors. One exception is the Structured Assessment of Protective Factors for Violence Risk (SAPROF), a tool that specifically focuses on protective factors which contribute to the desistance from violence and that can offer positive guidelines for strengths-based treatment. However, in long-term care, targeting protective factors can be particularly difficult or unrealistic, since patients have less opportunities for community reintegration and the focus in treatment often lies mainly on the patient’s functioning within the inpatient setting. To improve the assessment and management of protective factors for patients in long-term forensic care, an additional manual to the SAPROF was recently developed that focuses specifically on protective factors deemed valuable for intensive care settings: the SAPROF Long-term Care (SAPROF-LC). In this chapter we provide a rationale for the focus on protective factors that are of particular importance for long-term stay patients and demonstrate an overview of the SAPROF-LC, illustrated by several short case examples.