External validity and anchoring heuristics: application of DUNDRUM-1 to secure service gatekeeping in South Wales
Royal College of Psychiatrists
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Background: Structured clinical judgement tools provide scope for the standardisation of forensic service gatekeeping. These same tools may also allow identification of heuristics in this important decision process. Method: Retrospective assessments using the DUNDRUM-1 triage tool were completed for 121 service users referred for the first time for possible forensic psychiatric admission in South Wales. Fifty cases were admitted to medium security, 49 were admitted to low security and 22 remained in open conditions. Results: DUNDRUM-1 total scores differed appropriately between different levels of security but only 5 of the 11 DUNDRUM-1 items differed between the groups. Regression revealed a decision process anchored on the ‘legal process’ and ‘immediacy of risk due to mental disorder’ items of the DUNDRUM-1 with between 86% and 98% of variability in service user placement explained. Conclusions: Service user placement was broadly aligned with DUNDRUM-1 recommendations. However not all triage items informed gatekeeping decisions and a heuristic anchoring process emerged. It remains to be seen whether decisions anchored in this way are effective or ineffective in this context.
Daniel Lawrence, Tracey-Lee Davies, Ruth Bagshaw, Paul Hewlett Pamela Taylor, & Andrew Watt (2017) External validity and anchoring heuristics: application of DUNDRUM-1 to secure service gatekeeping in South Wales, BJPsych Bulletin, 42 (1), pp.10-18
This article was published in BJPsych Bulletin on 30 January 2018 available open access at https://doi.org/10.1192/bjb.2017.6
Cardiff Metropolitan University (Grant ID: Cardiff Metropolian (Internal))
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