Community Forensic Mental Health Research Articles

Differences in Risk for Sexual Violence Protocol (RSVP) risk factors among older and adult men who have sexually offended

ABSTRACT Ageing has a protective impact on recidivism risk, including for those who offend sexually (Ambroziak, G., Kahn, R. E., Mundt, J. C., Keiser, K. L., & Thornton, D. (2020). Are civilly detained and committed sexually violent persons released after age 60 low risk? Criminal Justice and Behavior, 48(7), 981–998; Doren, D. M. (2006). What do we know about the effect of aging on recidivism risk for sexual offenders? Sexual Abuse: A Journal of Research and Treatment, 18; Harris, G. T., & Rice, M. E. (2007). Adjusting actuarial violence risk assessments based on aging or the passage of time. Criminal Justice and Behavior, 34(3), 297–313). Recent research of the Risk for Sexual Violence Protocol (RSVP) suggests increased age may affect the validity of this guideline, with good predictive performance in samples of men mostly aged under 50 (Davis, M. R., Woods, M., Raymond, B., Ogloff, J. R. P., & McEwan, T. E. (in submission). Does it work? Convergent and predictive validity of the Risk for Sexual Violence Protocol (RSVP) in an Australian Community Forensic Mental Health Setting. Manuscript submitted for publication; Vargen, L. M., Jackson, K. J., & Hart, S. D. (2020). Interrater reliability, concurrent validity, and predictive validity of the Risk for Sexual Violence Protocol. Law and Human Behavior, 44(1), 37–50), but poor predictive performance in a sample aged over 50 (Raymond, B. C., Davis, M. R., Ogloff, J. R. P., & McEwan, T. E. (in submission). Convergent and predictive validity of the sexual violence risk-20 and risk for sexual violence protocol with older sexual offenders. Manuscript submitted for publication). This study investigated possible reasons for these contrasting results by investigating age-related differences in risk factor endorsement and the relationships between risk factors. RSVP risk factors in two samples of men with prior sexual offending, older adults aged between 50 and 78 (n = 95) and adults aged between 18 and 46 (n = 139). Few differences were identified in risk factor endorsement or the relationship between risk factors. The younger adult sample were observed to have more risk factors present. PRACTICE IMPACT STATEMENT This research adds to the literature regarding older men who offend sexually. It is anticipated that further research into factors that are associated with this age group, may encourage future research of gerontological literature in a forensic arena. Until more reliable evidence is available, the current risk assessment tools may require a level of caution when used with older men.

A UK-wide survey of community forensic services for adults with intellectual disability and/or autism.

Specialist forensic community teams for people with intellectual disability and/or autism have been developed, but little is known about their extent and delivery. To describe specialist forensic community teams for people with intellectual disability and/or autism across the UK. An online survey was sent to representatives of each UK Trust/Health Board providing adult mental health and/or intellectual disability services. Questions covered the availability, structure and activities of specialist community forensic services. Quantitative data were summarised and associations between access to specialist forensic teams and care were tested with Chi-squared tests. Thematic analysis of free-text survey responses was used to understand the challenges of providing community forensic mental health services for this group. A total of 49 out of 78 (63%) eligible Trusts/Health Boards responded, of which 25 (51%) had access to a specialist forensic community team. Teams operated either as part of a single Trust/Board (n = 13) or over a larger regional footprint (n = 12). The availability of specialist forensic community teams was associated with better access to offence-related interventions (χ2 = 15.1002, P < 0.005) and co-production of patient care plans (χ2 = 7.8726, P = 0.005). Respondents reported a wide variation in availability, expertise and perceived quality of community services. The availability of secure and generic in-patient beds, commissioning and legal barriers were also significant challenges in providing appropriate care. Coverage of specialist community forensic teams is not universal. There are indications that such teams are associated with improved care processes, but further work is needed to establish longer-term outcomes and the optimal model of care.

The role of Qatar's first forensic community team in reducing recidivism and re-admission of mentally unwell offenders.

Introduction: Qatar established its Community Forensic Mental Health Team (CFMHT) in 2019 as part of the region's first comprehensive forensic psychiatry service. We present here the data on clinical and offending outcomes since its establishment and compare this with data from before the service was established. Objectives: To compare clinical and offending outcomes in mental health patients with criminal offending histories in Qatar before and after the establishment of CFMHT. Methods: This is a retrospective study comparing the socio-demographical characteristics, clinical outcome and recidivism measures of forensic patients, under the CFMHT for the last 2 years with data from a similar period before the services were in place. Results: Data for 85 patients under the active care of forensic community team were matched with a comparable group before the establishment of the services. The re-admission and reoffending rates after the establishment of the service over 2-year follow-up were 17.6% and 12.9%, respectively, compared with 40% and 32% before the service. Conclusions: Since its inception, the CFMHT has made a significant positive impact on quality of life, mental well-being and safety of patients under its care. Close working relationships with the criminal justice system, families and carers have helped fight stigma and promote safer communities.

There and back again: staff and service user perspectives on readmission to a secure mental health hospital

PurposeReadmission to hospital can be distressing, costly for the National Health Service (NHS) and legally it should be a last resort as it entails restriction of liberty. This study aims to develop an understanding of factors leading to readmission for a cohort of service users under the care of a community forensic mental health team (CFMHT) in England to consider how support could be improved to reduce incidence of future readmissions.Design/methodology/approachThematic analysis was used to examine case recording relating to 13 service users who were readmitted to hospital within a specified time period. The same service users were invited to complete questionnaires regarding their views of what contributed to the readmission to cross-reference with themes identified.FindingsThe analysis of case notes produced eight sub-themes. These were sorted into three overarching themes, illustrating the challenges that service users face upon discharge from hospital, the sense they make of these challenges and the impact upon relational patterns, in particular with the CFMHT. Researchers highlight that the multiple challenges can increase service users’ sense of being under threat which can lead to distrust of professionals.Practical implicationsPractical suggestions arising from the study were fed back to the subject team and are listed at the end of the paper.Originality/valueFindings from this study parallel those previously reported. This study contributes an inter-relational aspect of the factors and the central role of meaning-making in the path of recovery and building a life in the community.

Delivering remote therapy during the COVID-19 pandemic: a qualitative study with service users accessing a community personality disorder service

PurposeThe purpose of this study is to qualitatively explore the views and opinions of service users accessing remote therapy through a community forensic personality disorder service during the COVID-19 pandemic.Design/methodology/approachA qualitative exploratory approach was adopted. Nine community forensic service users accessing virtual/telephone therapy through a community forensic mental health service were interviewed using semi-structed interviews. Data was analysed using Braun and Clarke (2006) thematic analysis techniques.FindingsAnalysis resulted in three overall themes: experience of communication in the therapeutic relationship; impacts of the change to remote working and making the best of what we have. A further seven subthemes were developed. A range of advantages and disadvantages to remote therapy were highlighted.Research limitations/implicationsThis study was based on a small sample of service users accessing one community forensic service in England, and therefore caution should be taken when generalising the findings. All interviews were conducted remotely and thus may have only supported those who are able to engage in this way.Practical implicationsThis paper has the potential to inform future remote therapy guidelines. Health services should consider keeping some elements of remote working and offering this as a choice to all service users.Originality/valueThis study is, to the best of the authors’ knowledge, the first study that attempts to explore the experiences of individuals accessing remote therapy within a forensic population who have personality disorders or traits.

Safer communities; how the first forensic community mental health team helped improve mental health, battle stigma, and reduce offending

IntroductionQatar established its Forensic Community Mental Health Team (FCMHT) in 2019 as part of the region’s first comprehensive forensic psychiatry service. We present here the data on clinical and offending outcomes since its establishment and compare this with data from before the service was establishedObjectivesTo compare clinical and offending outcomes in mental health patients with criminal offending histories in Qatar before and after the establishment of Forensic Community Mental Health Team (FCMHT).MethodsThis is a retrospective study comparing the socio-demographical characteristics, clinical outcome and recidivism measures of forensic patients, under the FCMHT for the last two years with data from a similar period before the services were in place.ResultsData for 170 patients in total was analyzed. 85 patients currently under the active care of forensic community team were matched with a comparable group before the establishment of the services. The re-admission and reoffending rates after the establishment of the service over 1 year of follow up was 15% and 20% respectively compared with 60% and 85% of the group before the service.ConclusionsSince its inception, the FCMHT has made significant positive impact on quality of life, mental well-being and safety of patients under its care. Close working relationships with criminal justice system, families and carers has helped fight stigma and promote safer community.DisclosureNo significant relationships.

An Audit of Compliance With NICE Guideline: Obesity: Identification, Assessment and Intervention by the Forensic Community Mental Health Team Based at a Supported Accommodation

AimsIn England, 64.8% of adults are currently classified as overweight or obese, with rates even higher in the North East at 68.6%, especially in adults with severe mental health illnesses. This additional body weight has the potential to increase the risk of developing a number of serious health conditions including diabetes, heart disease and even cancer. Studies have shown that patients with schizophrenia have a 2.8–3.5 increased likelihood of significant weight gain and reduction in life expectancy of 15–20 years, mainly due to preventable physical illness. Monitoring of risk factors for this, particularly weight gain, is therefore crucial. The NICE Guideline (2014) recommends that patients are routinely categorised into BMI categories to assist with obesity identification, management, and monitoring. A waist measurement is also advised to help with risk stratification. Patients with psychosis or schizophrenia, especially those taking anti-psychotics are also recommended to be offered a combined healthy eating and physical activity programme by their mental healthcare provider. Finally, patients with rapid or excessive weight gain, abnormal lipid levels or problems with blood glucose management should be offered appropriate interventions. Our main objective was to identify whether the obesity assessment, monitoring and intervention care delivered by our community team is in line with current guidance.MethodsA total of 12 residents living in community forensic supported accommodation and currently taking antipsychotic medications were included. Data reviewed were from September 2020 to September 2021. Data audited were from electronic medical records.ResultsThis audit found that 10 out of 12 patients (83%) fell into either the overweight or obese BMI categories (seven obese and three overweight). Only four patients had agreed to have their waist circumference measured, which meant only four patients were able to be appropriately risk stratified. One patient was identified as pre-diabetic and another diabetic. All patients identified to be overweight or obese received appropriate lifestyle advice. Qrisk scores, to assess cardiovascular risk, were calculated for the majority of eligible patients, except for two.ConclusionThis audit highlights that patients who are on regular antipsychotic treatment and living in the community are at high risk of obesity and its associated complications. It is important to perform regular health checks in this cohort due to this risk, both to improve their quality of life and prevent significant morbidity and mortality. Waist circumference measurements should be encouraged to enable risk stratification and accurate documentation will enable timely treatment intensification.

Using the Nominal Group Technique to determine a nursing framework for a forensic mental health service: A discussion paper.

The Nominal Group Technique is a method used to explore issues, generate ideas, and reach consensus on a topic. The Nominal Group Technique includes individual and group work and is designed to ensure participants have the same opportunity to engage and provide their opinions. While the technique has been used for around six decades to assist groups, in industry, and government organizations to examine issues and make decisions, this technique has received limited attention in nursing research, particularly in mental health. This discussion paper describes the use of a modified Nominal Group Technique for a study designed to determine a nursing decision‐making framework for a state‐wide forensic mental health service. Modifications were made to the traditional technique, to enable participants to make an informed and collective decision about a suitable framework for the novice to expert nurses, across secure inpatient, prison, and community forensic mental health settings. The Nominal Group Technique generated rich data and offered a structured approach to the process. We argue that the Nominal Group Technique offers an exciting and interactive method for nursing research and can increase opportunity for minority group members to participate. This technique also offers a time efficient way to engage busy clinical nurses to participate in research, with the advantage of members knowing the decision on the day of the group. Consideration, however, needs to be given to the duration and effect on participant concentration, and if not actively managed by facilitators, the possible emergence of group dynamics affecting individuals' decisions.

A Qualitative Study on Sexuality and Sexual Experiences in Community Forensic Mental Health Patients in Queensland, Australia.

This qualitative study reports on the sexuality and sexual experiences of community-based forensic mental health participants. The findings indicate that these participants feel the need for intimacy and want to engage in sexual activity more often than their neurotypical Australian peers. Participants identified their mental health and the side effects of compliance with prescribed psychotropic medications were barriers to achieving their desired level of sexual activity. Participants supported the notion that mental health teams were positioned to assist patients navigate the psychological, cultural, education and physical barriers to achieving sexual health and wellbeing. We propose several interventions to support these participants and other community forensic mental health patients in attaining healthy relationships, understanding their sexual health, and gaining more fulfilling sexual experiences. These interventions, which include sex education, upskilling in socialization and communication, and regular medication reviews, could be delivered as part of the holistic care provided by mental health teams. Mental health clinicians should be offered appropriate training to assess patients and have discussions related to sexuality, sexual experiences and sexual health needs.

Strategies Employed by Forensic Community Mental Health Nurses to Resolve Difficulties in Supporting Offenders With Mental Disorders Under the Medical Treatment and Supervision Act in Japan.

This study aimed to identify the strategies used by forensic community mental health nurses to resolve difficulties in supporting offenders with mental disorders under the Medical Treatment and Supervision Act in Japan. Interviews were conducted with 13 nurses, and the data were analyzed using content analysis. The study identified the strategies for difficulties in (a) assessing and managing risk potential of forensic service patients, (b) addressing offending behavior, (c) managing the transition of patients, (d) supporting patients to understand the impact of justice processes and applying knowledge of legislation to nursing, and (e) promoting the role of forensic community mental health nurses within the multidisciplinary team. The findings can benefit and support forensic community mental health nurses' practices. The Japanese forensic community mental health nurses experiencing difficulties and providing home visits to patients can utilize the identified strategies.

Accessing and engaging with primary health care services following discharge from forensic secure services: the perspectives of service users and mental health practitioners

PurposePhysical health inequalities and mortality rates are higher amongst individuals with severe mental illness (SMI), including among forensic populations, than the general population. This paper aims to explore the experiences of individuals accessing primary health care following discharge from secure services, and the practitioners who support them.Design/methodology/approachFace-to-face qualitative interviews were conducted with service users (n = 4) and mental health practitioners (n = 4) within a forensic community mental health team in one NHS Trust in England in 2019. Data were analysed using the Interpretative Phenomenological Analysis.FindingsFour super-ordinate themes emerged: perceived importance of physical health, agency, responsibility and relationships. Service users mostly saw themselves as passive recipients of health care and prioritised their mental health over their physical health. Close working relationships meant that mental health practitioners were often the first contact for service users with any health issue and thus felt a sense of responsibility for their physical health care. Service users who did access primary care reported that consistency of professional, feeling understood and listened to without judgement or stigma were important.Practical implicationsInterventions for service users that include practicalities and strategies to facilitate independence in physical health care, and collaborative working between primary care and forensic mental health services, are encouraged.Originality/valueThis study highlights some of the unique challenges in forensics around improving physical health outcomes for individuals with SMI.

Audit of physical health monitoring in a forensic psychiatric community caseload

AimsAdherence to Cumbria Northumberland Tyne and Wear NHS Foundation (CNTW) Trust physical health monitoring guidelines for a caseload of community forensic psychiatry patients residing at Westbridge supported accommodation was audited to identify areas for improvement in practice. It was also our aim to highlight the delay in obtaining non-urgent investigations due to the need to minimize COVID infection transmission risks.MethodData were collected from mental health and acute trust electronic records (Rio and ICE) of all patients taking antipsychotic medications currently care coordinated by the Westbridge Forensic Community Mental Health Team (FCMHT) between January 2020 and January 2021 (8 patients). Analysis of compliance with standards set by Trust guidelines was made.ResultIn the chosen audit period, compliance with physical health monitoring standards was below target of 100% (80% compliance for bloods, 50% for ECG). Reasons for non-compliance were unexpected restrictions in service availability (e.g. temporary closure of walk-in ECG clinic) and one omission of sending a prolactin levels request.ConclusionThe need for practice adaptation and advance planning by team in anticipation of potential delays was identified. Request for routine bloods and ECGs will now be made two months before the annual due dates to compensate for delays in the new process with plan to continue re-audit yearly.

Attitudes towards offenders with intellectual disability

Purpose Public attitudes are considered influential in the successful reintegration of offenders into society after release, however research into attitudes towards offenders with intellectual disability (ID) has received little attention. The purpose of this study is firstly to see if people hold differing attitudes towards the reintegration of offenders with ID compared to those without ID and secondly, to investigate whether this difference in attitude is because of differing implicit theories of intelligence (TOI). The effects of familiarity with ID were also measured. Design/methodology/approach In total, 200 participants read crime vignettes depicting crimes committed by offenders with and without ID and completed Dweck’s “TOI” scale. Findings Participants were found to have greater entity views of intelligence towards ID yet displayed more positive attitudes towards their reintegration than offenders without ID. The influence of demographics was mixed. It would appear attitudes towards offenders with ID are not as negative as initially thought. Research limitations/implications Implications of these findings are discussed in terms of desistance and community integration. Practical implications While some care must be taken when interpreting the results, this study demonstrates positive results regarding the reintegration of offenders with ID. Attitudes may be changing for the better towards those with disabilities, which is positive in terms of the government and National Health Service (NHS) objectives to reintegrate people with ID successfully back into the community. Although limited in number, it is noted that community forensic mental health teams have been effective in managing offender risk and providing good quality care (Dinani,et al.,2010; Benton and Roy, 2008). They can provide more person-centred and specialist treatments options and have links with other community services, probation and the police (Royal College of Psychiatrists, 2014). Social implications Community care is thought to lead to more timely treatments with more accessible support teams and services that those with ID would struggle to access in prison (Bradley, 2009). It can also lead to greater well-being and support as individuals are in a less restrictive environment and are closer to their social networks, acting as a protective factor against further reoffending (Benton &amp; Roy, 2008; Bradley, 2009). Furthermore, it has been indicated significant financial savings would be achieved for the criminal justice system by reducing inpatient care and increasing community services and sentences, in addition to reducing the demand on prison spaces (Bradley, 2009; Benton &amp; Roy, 2008). Originality/value To date, very few studies have used TOI to examine attitudes towards offenders, with none examining attitudes towards offenders with ID.

Barriers and facilitators to the implementation of individual placement and support (IPS) for patients with offending histories in the community: The United Kingdom experience

Introduction We aimed to identify the barriers and facilitators to the implementation of a high fidelity individual placement and support service in a community forensic mental health setting. Method In-depth interviews were conducted with clinical staff ( n = 11), patients ( n = 3), and employers ( n = 5) to examine barriers and facilitators to implementation of a high fidelity individual placement and support service. Data was analysed using thematic analysis, and themes were mapped onto individual placement and support fidelity criteria. Results Barriers cited included competing interests between employment support and psychological therapies, perceptions of patients’ readiness for work, and concerns about the impact of returning to work on welfare benefits. Facilitators of implementation included clear communication of the benefits of individual placement and support, inter-disciplinary collaboration, and positive attitudes towards the support offered by the individual placement and support programme among stakeholders. Offences, rather than mental health history, were seen as a key issue from employers’ perspectives. Employers regarded disclosure of offending or mental health history as important to developing trust and to gauging their own capacity to offer support. Conclusions Implementation of individual placement and support in a community mental health forensic setting is complex and requires robust planning. Future studies should address the barriers identified, and adaptations to the individual placement and support model are needed to address difficulties encountered in forensic settings.

Risk Factors for Stalking Recidivism in a Dutch Community Forensic Mental Health Sample

abstractThere are few studies of stalking recidivism and none examining risk factors for recidivistic stalking of the same victim versus a different victim. Data from 70 clients of Dutch community forensic mental health clinics was used to investigate the prevalence of stalking recidivism, risk factors, and any potential protective effect of psychological treatment. Over 50% were again reported to police for stalking over two years, including 21% who stalked a new victim. No risk factors were significantly related to future stalking and psychological treatment was unrelated to recidivism. Possible explanations for these findings and directions for future research are discussed.

Implementation of individual placement and support (IPS) into community forensic mental health settings: Lessons learned

Introduction Assessment of the effectiveness of individual placement and support in forensic mental health settings is a relatively new field of research despite evidence demonstrating its effectiveness in generic mental health settings. Method IPS was implemented into a community forensic mental health setting within a large National Health Service trust in the United Kingdom over 6 months. Using the Consolidated Framework for Implementation Research this paper describes the lessons learned from implementing individual placement and support into such settings. Results Our findings suggest that implementation of individual placement and support in forensic mental health settings is complex and requires robust planning and collaboration with internal and external agencies. Barriers to implementation included staff attitudes, difficulty engaging employers and lack of employment related performance indicators, and facilitators included the support of service managers and outside groups. Adaptations to the IPS model were made to address challenges encountered, including difficulty starting rapid job searches, concerns about stigma, lack of confidence, uncertainty around employment opportunities, offence restrictions and lack of interest from potential employers. Conclusion This paper adds to the limited literature in the field. Findings are relevant to practitioners and service providers who wish to implement individual placement and support services for people with mental disorder and offending histories.

Review of psychiatric services to mentally disordered offenders around the Pacific Rim

This article was commissioned to collate and review forensic psychiatric services provided in a number of key Pacific Rim locations in the hope that it will assist in future dialogue about service development. The Board of the Pacific Rim College of Psychiatrists identified experts in forensic psychiatry from Australia, Canada, China, Hong Kong, Japan, Russia, Singapore, Taiwan, and the US. Each contributor provided an account of issues in their jurisdiction, including mental health services to mentally disordered offenders in prison, competence or fitness to stand trial, legal insanity as a defense at trial, diminished responsibility, and special forensic services available, including forensic hospitals and community forensic mental health services. Responses have been collated and are presented topic by topic and country by country within the body of this review. The availability of mental health screening and psychiatric in-reach or forensic liaison services within prisons differed considerably between countries, as did provisioning of community forensic mental health and rehabilitation services. Diversion of mentally disordered offenders to forensic, state, or hybrid hospitals was common. Legal constructs of criminal responsibility (insanity defense) and fitness to stand trial ("disability") are almost universally recognized, although variably used. Disparities between unmet needs and resourcing available were common themes. The legislative differences between contributing countries with respect to the mental health law and criminal law relating to mentally disordered offenders are relatively subtle. The major differences lie in operationalizing and resourcing forensic services.

An examination of the relationship between personality and aggression using the general aggression and five factor models

This study examined the relationships between personality and aggression using the general aggression (GAM, Anderson and Bushman [2002] Annual Review of Psychology, 53, 27-51) and five factor models (FFMs) (Costa and McCrae [1992] Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) professional manual. Odessa, FL: Psychological Assessment Resources). Specifically, it examined Ferguson and Dyck's (Ferguson and Dyck [2012] Aggression and Violent Behavior, 17, 220-228) criticisms that the GAM has questionable validity in clinical populations and disproportionately focuses on aggression-related knowledge structures to the detriment of other inputs, specifically personality variables. Fifty-five male offenders attending a community forensic mental health service for pre-sentence psychiatric and/or psychological evaluation were assessed for aggressive script rehearsal, aggression-supportive normative beliefs, FFM personality traits, trait anger and past aggressive behavior. With regard to relationships between five factor variables and aggression, results suggested that only agreeableness and conscientiousness were related to aggression. However, these relationships were: (1) weak in comparison with those between script rehearsal, normative beliefs and trait anger with aggression and (2) were not significant predictors in hierarchical regression analysis when all of the significant univariate predictors, including GAM-specified variables were regressed onto life history of aggression; normative beliefs supporting aggression, aggressive script rehearsal, and trait anger were significantly related to aggression in this regression analysis. These results provide further support for the application of the GAM to aggressive populations.

HCR-20 Risk Profiles of Patients Referred to Forensic Mental Health Services in New South Wales

The present study aimed to consider the HCR-20 risk profiles of forensic and civil (i.e. general psychiatric) patients referred to forensic mental health services (FMHS), in the state of New South Wales (NSW), Australia. It was hoped that by better understanding patient risk, based on HCR-20 ratings, more could be understood about the differing needs of the two patient groups. Data gathered from comprehensive assessments undertaken by trained clinicians across two service settings, a medium secure forensic facility and the NSW Community Forensic Mental Health Service (CFMHS) was utilised. Data from 129 forensic patients and 105 civil patients were included. T-tests indicated significant differences between means of civil and forensic patients on the HCR-20 and odds ratios (ORs) indicated civil patients referred to FMHS were approximately six times more likely to fall into the high-risk category on the HCR-20 (i.e. score 25 or >) than forensic patients. The nature and level of risk evident between forensic and civil patients referred to FMHS in NSW highlighted two issues: (1) The differing risk/need inherent in two patient groups accessing FMHS; and (2) The level of risk observed in civil patients referred to FMHS and therein the challenges faced by generalist mental health services in managing this patient group. The need for generalist mental health services to be better supported and the need for structured, evidence-based risk management practice to be extended to civil psychiatric patient care was indicated.

Structured Risk Assessment in Community Forensic Mental Health Practice

This paper will examine the use of the Historical Clinical Risk Management-20 (HCR-20) by Australian community forensic mental health services (CFMHS) and explore some key issues involved in the application of Structured Professional Judgment (SPJ) risk assessment tools in clinical practice. We used a survey of the use of the HCR-20 by 10 Australian CFMHSs. During the 12-month survey period, the number of assessments conducted ranged from 6 to 186 (median 55). Differences in service models impacted on who was seen, whether reassessments were undertaken, and involvement of generalist mental health staff. Most services employed quality assurance processes and accessed qualified trainers. The use of SPJ tools acknowledges the role of professional judgment while also providing a structure to ensure that relevant evidence-based factors are taken into account. The survey highlighted service model variation as well as the importance of training and quality assurance processes required to ensure that comprehensive violence risk assessments are completed in a valid and reliable fashion.