Use of the HCR-20 for violence risk assessment: views of clinicians working in a secure inpatient mental health setting
| Pages | 130-138 |
| Published date | 08 May 2017 |
| Date | 08 May 2017 |
| DOI | https://doi.org/10.1108/JFP-08-2016-0039 |
| Author | Geoffrey L. Dickens,Laura E. O’Shea |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice,Sociology,Sociology of crime & law,Law enforcement/correctional,Public policy & environmental management,Policing,Criminal justice |
Use of the HCR-20 for violence risk
assessment: views of clinicians working in
a secure inpatient mental health setting
Geoffrey L. Dickens and Laura E. O’Shea
Abstract
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 ¼45 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.
Keywords Risk assessment, HCR-20, Violence, Risk management, Aggression, Survey
Paper type Research paper
Background
Structured professional judgement (SPJ) approaches are recommended for the assessment of
risk for violence among criminal justice and mental health populations (National Institute for
Mental Health in England, 2004). SPJ tools, including the Historical Clinical Risk management-20
(HCR-20; Webster et al., 1997) and the Short Term Assessment of Risk and Treatability
(START; Webster et al., 2009), include schedules of empirically grounded risk factors whose
presence, partial presence, or absence raters are required to determine.
SPJ tools differ from actuarial schemes in which a numerical score is calculated, compared with
data from validation samples, and used to determine a non-discretionary risk-level assignation
according to predetermined cut-off scores. In contrast, SPJ relies on an idiographic reading of
the individual patient’s risk factor assessment, together with other relevant considerations,
before a final risk level (usually high, medium, or low) is assigned at the raters’discretion and
Received 10 August 2016
Revised 29 September 2016
Accepted 30 September 2016
Geoffrey L. Dickens is a
Professor in Mental Health
Nursing at the School of Health
and Social Sciences, Abertay
University, Dundee, UK.
Laura E. O’Shea is based at the
Research Department,
St Andrew’s Healthcare,
Northampton, UK.
PAGE130
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JOURNAL OF FORENSIC PRACTICE
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VOL. 19 NO. 2 2017, pp. 130-138, © Emerald Publishing Limited, ISSN 2050-8794 DOI 10.1108/JFP-08-2016-0039
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