Do scores on the HCR-20 and FAM predict frequency of self-harm in females within a secure psychiatric hospital?

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The Historical, Clinical, and Risk Management scales (HCR-20) and the Female Additional Manual (FAM) are violence risk assessment tools. This study aimed to examine whether scores on the HCR-20 and FAM are related to frequency of self-harm. HCR-20 Version 3 and FAM scores and frequency of self-harm across the following year were examined for 89 female patients within a secure psychiatric hospital. The results showed that higher mean total scores on the HCR-20, and also on the Historical and Clinical scales were associated with more frequent self-harm, both with and without the FAM items. The Risk Management scale was not associated. Eight individual items were positively associated with self-harm, and one was negatively associated. The final risk judgement for self-destructive behaviour was also positively associated with self-harm. The HCR-20 and FAM are useful tools for assessing risk of self-harm, particularly the Historical and Clinical scales. However, not all items are independently associated with more frequent self-harm. Final risk judgements are also an accurate indicator of frequency of self-harm, and therefore the process of completing the HCR-20 and FAM may aid accurate self-harm risk assessment.