Assessing living skills in forensic mental health care with the behavioural status index: a European network study

Assessment of living skills and violence risk in forensic psychiatric patients is a priority for clinicians. Suitably fine-grained instruments are rare. The goal of this study was to compare a norm-based psychometric assessment battery (the Behavioural Status [BEST] Index) with known valid instruments. Parallel cohort studies were undertaken in four European countries. Inpatients from 24 forensic psychiatric clinics were assessed three times using five instruments measuring living skills, psychological symptoms, aggression, and violence risk. Positive clinical changes were noted in insight, empathy, and some behaviors related to communication and living skills, with little change in violence risk, which was low to medium for most patients. Clinical congruence was observed between logically cognate items of the BEST Index and comparison instruments. Evidence for the scientific and clinical utility of the BEST Index as an effective tool for forensic psychiatric practice is discussed.