Some Questions for the Field of Violence Risk Assessment and Forensic Mental Health: Or, “Back To Basics” Revisited

2002 ◽  
Vol 1 (2) ◽  
pp. 171-178 ◽  
Author(s):  
Thomas R. Litwack
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Violence Risk ◽  
Forensic Mental Health ◽  
Violence Risk Assessment

Predictions of Violence

2018 ◽  
pp. 143-157
Author(s):  
John Monahan
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Criminal Justice ◽  
Central Issue ◽  
Violence Risk ◽  
Historical Account ◽  
Violence Risk Assessment ◽  
Comprehensive Review ◽  
Psychology And Law ◽  
Criminal Justice Systems

This chapter presents an historical account of the emergence of violence risk assessment as a central issue in what were portrayed as reforms of the mental health and criminal justice systems in the 1970s. The author traces his own involvement in the nascent field of psychology and law to his writing the first comprehensive review of research on the validity of violence risk assessment. The chapter then details the major theoretical, empirical, and policy strides that characterized violence risk assessment as it matured over the next several decades. The author concludes by reflecting on several issues whose resolution has proved elusive.

Violence risk instruments may be culturally unsafe for use with Indigenous patients

2016 ◽  
Vol 24 (6) ◽  
pp. 565-567 ◽  
Author(s):  
Stephane M Shepherd
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Forensic Assessment ◽  
Cross Cultural ◽  
Indigenous Australians ◽  
Violence Risk ◽  
Forensic Mental Health ◽  
Current Form ◽  
Health Decision Making ◽  
Health Decision

Objective: Violence risk assessment assumes a critical medico-legal role addressing offender/patient needs and informing forensic mental health decision making. Yet questions remain over the cross-cultural applicability of such measures. In their current form, violence risk instruments may not reflect the unique life and cultural experiences of Indigenous Australians rendering them culturally unsafe. Conclusions: To realize equitable forensic assessment, it is necessary to ascertain whether there are cultural differences across risk factors for violence and that risk instruments are validated as culturally appropriate. Greater cross-cultural rigour in forensic mental health risk assessment, research and practice is proposed.

scholarly journals Assessment of violence risk in 440 psychiatric patients in China: examining the feasibility and acceptability of a novel and scalable approach (FoVOx)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shaoling Zhong ◽  
◽  
Rongqin Yu ◽  
Robert Cornish ◽  
Xiaoping Wang ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Risk Assessment ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Psychiatric Patients ◽  
Clinical Decision ◽  
Violence Risk ◽  
Violence Risk Assessment ◽  
Risk Categories

Abstract Background Violence risk assessment is a routine part of clinical services in mental health, and in particular secure psychiatric hospitals. The use of prediction models and risk tools can assist clinical decision-making on risk management, including decisions about further assessments, referral, hospitalization and treatment. In recent years, scalable evidence-based tools, such as Forensic Psychiatry and Violent Oxford (FoVOx), have been developed and validated for patients with mental illness. However, their acceptability and utility in clinical settings is not known. Therefore, we conducted a clinical impact study in multiple institutions that provided specialist mental health service. Methods We followed a two-step mixed-methods design. In phase one, we examined baseline risk factors on 330 psychiatric patients from seven forensic psychiatric institutes in China. In phase two, we conducted semi-structured interviews with 11 clinicians regarding violence risk assessment from ten mental health centres. We compared the FoVOx score on each admission (n = 110) to unstructured clinical risk assessment and used a thematic analysis to assess clinician views on the accuracy and utility of this tool. Results The median estimated probability of violent reoffending (FoVOx score) within 1 year was 7% (range 1–40%). There was fair agreement (72/99, 73% agreement) on the risk categories between FoVOx and clinicians’ assessment on risk categories, and moderate agreement (10/12, 83% agreement) when examining low and high risk categories. In a majority of cases (56/101, 55%), clinicians thought the FoVOx score was an accurate representation of the violent risk of an individual patient. Clinicians suggested some additional clinical, social and criminal risk factors should be considered during any comprehensive assessment. In addition, FoVOx was considered to be helpful in assisting clinical decision-making and individual risk assessment. Ten out of 11 clinicians reported that FoVOx was easy to use, eight out of 11 was practical, and all clinicians would consider using it in the future. Conclusions Clinicians found that violence risk assessment could be improved by using a simple, scalable tool, and that FoVOx was feasible and practical to use.

The evolution of violence risk assessment

CNS Spectrums ◽  
2014 ◽  
Vol 19 (5) ◽  
pp. 419-424 ◽  
Author(s):  
John Monahan ◽  
Jennifer L. Skeem
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Risk Assessments ◽  
Violence Risk ◽  
Mental Health Clinicians ◽  
Violence Risk Assessment ◽  
Many Instruments ◽  
Better Than

Many instruments have been published in recent years to improve the ability of mental health clinicians to estimate the likelihood that an individual will behave violently toward others. Increasingly, these instruments are being applied in response to laws that require specialized risk assessments. In this review, we present a framework that goes beyond the “clinical” and “actuarial” dichotomy to describe a continuum of structured approaches to risk assessment. Despite differences among them, there is little evidence that one instrument predicts violence better than another. We believe that these group-based instruments are useful for assessing an individual's risk, and that the instrument should be chosen based on the purpose of the assessment.

scholarly journals Use of the HCR-20 for violence risk assessment: views of clinicians working in a secure inpatient mental health setting

2017 ◽  
Vol 19 (2) ◽  
pp. 130-138 ◽  
Author(s):  
Geoffrey L. Dickens ◽  
Laura E. O’Shea
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Online Survey ◽  
Predictive Accuracy ◽  
Violence Risk ◽  
Violence Risk Assessment ◽  
Cross Sectional Survey ◽  
Vast Number ◽  
Content Type ◽  
Historical Factors

Purpose The purpose of this paper is to explore how raters combine constituent components of Historical Clinical Risk-20 (HCR-20) risk assessment, and how relevant they rate the tool to different diagnostic and demographic groups. Design/methodology/approach A cross-sectional survey design of n=45 mental health clinicians (psychiatrists, psychologists, and others) working in a secure hospital responded to an online survey about their risk assessment practice. Findings HCR-20 Historical and Clinical subscales were rated the most relevant to violence prediction but four of the five items rated most relevant were Historical items. A recent history of violence was rated more important for risk formulation than Historical and Risk management items, but not more important than Clinical items. While almost all respondents believed predictive accuracy would differ by gender, the tool was rated similarly in terms of its relevance for their client group by people working with men and women, respectively. Research limitations/implications This was an exploratory survey and results should be verified using larger samples. Practical implications Clinicians judge recent violence and Clinical items most important in inpatient violence risk assessment but may overvalue historical factors. They believe that recent violent behaviour is important in risk formulation; however, while recent violence is an important predictor of future violence, the role it should play in SPJ schemes is poorly codified. Social implications It is important that risk assessment is accurate in order to both protect the public and to protect patients from overly lengthy and restrictive detention. Originality/value Despite the vast number of studies examining the predictive validity of tools like HCR-20 very little research has examined the actual processes and decision-making behind formulation in clinical practice.

scholarly journals The reliability and validity of the SAPROF among forensic mental health patients

2021 ◽  
Author(s):  
Sandra Oziel
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Risk Management ◽  
Protective Factors ◽  
Predictive Validity ◽  
Violence Risk ◽  
Forensic Mental Health ◽  
Institutional Misconduct ◽  
Forensic Psychologists ◽  
Mental Health Patients

Assessing and managing level of risk among forensic mental health patients is a primary role of clinical forensic psychologists. Forensic assessments are focused on risk factors and deficits, whereas patient strengths and protective factors are either partially included or overlooked altogether by forensic psychologists. As a result, less is known about protective factors in general and how they may serve to inform risk management practices. The Structured Assessment of Protective Factors for Violence Risk (SAPROF) is the first tool to exclusively rely on protective factors and was investigated for the current study. The psychometric properties of the SAPROF were examined using a sample of 50 Canadian patients found Not Criminally Responsible (NCR) at a psychiatric hospital using both file information and semi-structured interviews. Outcome variables included risk management decisions (change in privilege level and security level) and indicators of recidivism (psychiatric medication administration, institutional misconduct and disposition breaches). The study found some evidence for intrarater and interrater reliability, construct validity, predictive validity and incremental predictive validity. The SAPROF approached significance for adding incremental predictive validity to the HCR-20 V3, a measure of violence risk, for disposition breaches and institutional misconduct, and effect sizes doubled. Given that the addition of the SAPROF increased the accuracy of the violence risk assessment, there are considerable implications for informing clinical practice. Implications for risk assessment, treatment planning, intervention and risk management decisions implemented by review boards and clinical practitioners are discussed. It is recommended that the SAPROF be added as an adjunct measure to risk assessment batteries and included in hospital reports, given that it predicted several patient behaviours.

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