Abstract

Aims and MethodWe surveyed the usage and perceived utility of standardised risk measures in 29 forensic medium secure units (a 62% response rate).ResultsThe most common instruments were Historical Clinical Risk–20 (HCR–20) and Psychopathy Checklist – revised (PCL–R); both were rated highly for utility. the Risk Matrix 2000 (RM2000), Sex Offender Risk Appraisal Guide (SORAG) and Static-99 were the most common sex offender assessments, but the Sexual Violence Risks–20 (SVR–20) was rated more positively for its use of dynamic factors and relevance to treatment.Clinical ImplicationsMost medium secure units use structured risk assessments and staff view them positively. As HCR–20 and PCL–R/PCL–SV (Psychopathy Checklist – Screening Version) are so widely used they should be the first choices considered by other services.

Highlights

  • If the unit accommodated people who were sex offenders, the process was repeated for sex offender risk assessments, namely the Rapid Risk Assessment for Sex Offence Recidivism (RRASOR; Hanson, 1997), Sex Offender Risk Appraisal Guide (SORAG; Quinsey et al, 1998), Static-99 (Hanson, 1997) and Risk Matrix 2000 (RM2000; Thornton, 2003)

  • Clinicians were unsure of best practices for sex offender risk assessment, as there was a bewildering array of tools, many developed from US prison populations with limited validation in UK populations

  • The reliability of the new internet database is unknown and some forensic units may have been omitted from the sample

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Summary

RESULTS

The most common instruments were Historical Clinical Risk-20 (HCR-20) and Psychopathy Checklist - revised (PCL-R); both were rated highly for utility. Most medium secure units use structured risk assessments and staff view them positively. Violence risk assessment is central to the work of forensic mental health services. The alternatives to clinical assessment alone are actuarial methods (e.g. using the Violence Risk Appraisal Guide (VRAG); Quinsey et al, 1998) that prescribe the collection and interpretation of data relevant to risk. Khiroya et al V|olence risk assessments in medium secure units original papers (e.g. previous violence, substance misuse, psychopathy); and structured clinical methods (e.g. Historical Clinical Risk-20 (HCR-20); Webster et al, 1997) which require collection of similar data and require the use of clinical discretion in using additional information and in how to interpret the data). The extent to which UK forensic mental health services have adopted these methods remains unknown

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