Use of the short term assessment of risk and treatability in a forensic facility: Examining the impact of suicide behavior on multiple risk outcomes

Jonathan Lam, Fordham University


The study evaluated the use of the Short Term Assessment of Risk and Treatability (START; Nicholls et al., 2007) to assess suicide behavior and NSSI risk at a forensic psychiatric hospital. The sample included 110 male inmates housed at Kirby Forensic Psychiatric Center (KFPC) for competency-related issues. This study addressed gaps in the literature by examining a broader range of self-harming behaviors within a forensic psychiatric population and investigated the use of the START in identifying risk for suicide behaviors and NSSI during a two-month follow-up period. The findings provided limited support for the study hypotheses. Examining groups by history of suicide attempts and NSSI revealed that START Total Vulnerability score was able to distinguish between those who had a history of NSSI and those who did not, but not between those with a history of suicide attempts, from those who did not. However, when looking at individual items, two risk factors for suicide attempts and NSSI in the community, correctional, and forensic settings (e.g., emotional state and impulsivity) were elevated for participants with a history of suicide attempts and those with a history of NSSI. This finding suggested that items are likely relevant to inform SPJ risk estimates of suicide and NSSI behaviors. There was limited evidence for the utility of the START in predicting future self-harming behaviors. Logistic regression analyses revealed that the Suicide SPJ risk estimate was not a consistent predictor for suicide behavior after accounting for lifetime history of suicide attempts. Neither history of NSSI nor the Self-Harm SPJ risk estimate were significant predictors of NSSI behavior. It is likely that the findings were influenced by the low base rate of suicide and NSSI behaviors within the follow-up period and possible problems with validity of the chart review and follow-up assessments used to form criterion groups. Taken together these results suggest that any clinical assessment of risk for self-harm behaviors should be informed by first understanding the history of suicide attempts and NSSI and augmented by more proximal indicators of emotion dysregulation and impulse control problems to better inform structured professional judgments on the START. Until further research is completed understanding the connections between item and risk estimate ratings, clinicians should be aware of the limited utility of the START risk estimates in correctly identifying patients who engage in suicide and NSSI behaviors in a forensic inpatient setting.

Subject Area

Mental health|Clinical psychology|Criminology

Recommended Citation

Lam, Jonathan, "Use of the short term assessment of risk and treatability in a forensic facility: Examining the impact of suicide behavior on multiple risk outcomes" (2014). ETD Collection for Fordham University. AAI3643381.