Predicting hospital aggression in secure psychiatric care

Area of Science:

• Forensic Psychiatry
• Clinical Psychology
• Risk Assessment

Background:

• Risk assessment instruments are widely used for predicting future aggression.
• These tools claim to offer reliable long-term aggression risk predictions.
• Their efficacy in high-security psychiatric settings requires ongoing evaluation.

Purpose of the Study:

• To evaluate the 12-month and 4-year predictive accuracy of the HCR-20 and VRAG.
• To assess the utility of these instruments for aggression risk in personality disordered patients.
• To determine the performance of actuarial versus structured professional judgment in this population.

Main Methods:

• Study involved adult male psychiatric patients in a high-secure hospital.
• All participants had a diagnosis of personality disorder.
• The primary outcome measured was aggression within the hospital setting.

Main Results:

• The Violence Risk Appraisal Guide (VRAG) outperformed the Historical, Clinical and Risk Management - 20 (HCR-20).
• Neither instrument demonstrated high overall predictive performance.
• Predictive value was more apparent over a 4-year period and for specific aggression types.

Conclusions:

• The study questions the overall clinical utility of HCR-20 and VRAG for aggression assessment in this specific patient group.
• Findings suggest limited predictive value, particularly for shorter timeframes.
• Further research may be needed to refine instruments or identify alternative assessment methods.