Structured risk assessment in community forensic mental health practice

Area of Science:

• Forensic Mental Health
• Clinical Psychology
• Risk Assessment

Background:

• Structured Professional Judgment (SPJ) tools enhance clinical decision-making in risk assessment.
• The Historical Clinical Risk Management-20 (HCR-20) is a widely used SPJ tool.

Purpose of the Study:

• To examine the utilization of the HCR-20 in Australian community forensic mental health services (CFMHS).
• To identify key issues in applying SPJ risk assessment tools within clinical practice.

Main Methods:

• A survey was conducted among 10 Australian CFMHSs regarding their use of the HCR-20.
• Data collection covered a 12-month survey period.

Main Results:

• The number of HCR-20 assessments varied significantly across services (median 55).
• Service delivery models influenced patient selection, reassessment practices, and generalist staff involvement.
• Most services implemented quality assurance measures and utilized trained professionals.

Conclusions:

• SPJ tools balance professional judgment with evidence-based factors for risk assessment.
• Variations in service models, training, and quality assurance are critical for valid and reliable violence risk assessments.