Search

The HCR-20, a widely used method of assessing and managing risk, relies on the structured professional judgement approach. This paper reports a narrative literature review of the HCR-20 studies to explore the applicability of the study results to the use of the HCR-20 in clinical practice. From a literature search using terms "HCR-20" and "HCR 20", 206 papers were included. Of studies using the HCR-20 version 2 (n = 191), 92% (n = 176) relied on variables based on scores derived by adding item scores, and 50% (n = 95) tested the HCR-20 using predictive validity methodology. Of the HCR-20 version 3 studies (n = 21), the "presence of risk factors" step was the most commonly examined (n = 18, 86%), but 2 of the 7 steps ("scenario planning" and "management") were not examined at all. Amongst those studies whose primary focus was on the HCR-20, 67% (n = 64/95) did so by assessing the predictive validity of the tool. Only one employed a design to test whether the use of the HCR-20 affected violence rates. The predominant study design provides support for the use of the HCR-20 as an actuarial tool, and there is limited empirical evidence in support of its effectiveness as a structured professional judgement approach to the assessment and management of the risk of violence., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Dynamic risk factors need to be assessed repeatedly over time rather than at a single time point to examine the relationship with violence. This predictive validity study sought to examine the degree of dynamic change in risk assessed in a group of mentally disordered offenders and the relationship between change and the occurrence of violence., Methods: Routine structured assessments of Strengths and Vulnerabilities on the Short-Term Assessment of Risk and Treatability (START) instrument (n = 475) were linked prospectively with 275 violent incidents using logistic regression in a sample of 50 patients., Results: Stability within patients estimated using the intra-class correlation coefficient was high (>.80) for both Strengths and Vulnerabilities. In the overall sample, a 10 point increase in START Vulnerabilities score was associated with a three-fold increased risk of violence (OR = 3.1; 95% CI, 1.47-7.46) but there was no association for Strengths score (OR = 0.91, 95% CI, 0.34-2.47). When examined within patients, both Vulnerabilities (OR = 1.77, 95% CI, 0.56-5.54) and Strengths (OR = 2.26, 95% CI, 0.38-13.42) were associated with an increased risk of violence but in both cases precision was low due to reduced sample sizes., Conclusions: Risk factors which are considered to have the capacity to fluctuate dynamically did not do so substantially in this group of mentally disordered offenders. When fluctuations did occur there was some tentative evidence that they are associated with violent outcomes and could guide the use of prevention measures.

Prospective longitudinal studies have shown strong predictions from conduct disorders (CDs) in childhood to antisocial personality disorder (ASPD) and violence in adults. However, little is known of the childhood antecedents of serious violence nor whether these may vary depending on the context in which the violence occurs. In this study, 54 men aged 21-40 years serving prison sentences for violent crime were assessed. Standardized interviews of ASPD and violence were conducted independently of interviews covering retrospective recall of childhood psychiatric disorders and adverse experiences. Analyses of the predictors of overall violence suggested a pathway involving childhood CD and adult ASPD associated with interparental discord, and an additional pathway associated with experiencing interparental violence in childhood. Different results were however obtained when account was taken of the context of the violence. The CD-ASPD pathway was associated with social violence, but not with partner violence. Partner violence was predicted by retrospective reports of having been exposed to interparental violence during childhood but not by reports of childhood CD or adult ASPD. Thus developmental pathways to serious violence may be different depending on the social domain in which the violence occurs., (Copyright 2008 Wiley-Liss, Inc.)

Background: Antisocial personality disorder (ASPD) identifies adults with persistent offending behaviour and social dysfunction. However, it lacks discrimination within high-risk and criminal populations and gives little indication of an individual's history of violence. Existing measures of violence have significant limitations. The Liverpool Violence Assessment (LiVA) is an investigator-based standardized interview for measuring patterns of violence., Method: A total of 61 male prisoners who had been sentenced for serious violent offences were interviewed using the LiVA and the Structured Clinical Interview for DSM IV antisocial personality disorder and alcohol and drug dependence. Official records of offending were examined., Results: The inter-rater reliability for the LiVA was high. There were significant correlations between histories of violence assessed by the LiVA and official records, but the frequency of self-reported violence was much higher than in the official records. Antisocial personality disorder was associated with increased violence. However, analyses revealed marked variability of the levels of violence among those with antisocial personality disorder and contrasting patterns of association of violence with antisocial personality disorder depending on the context., Conclusion: The LiVA is a reliable and valid measure of the patterns and characteristics of violence. The findings suggest that the causes of violence should be studied in their own right and not only as a feature of ASPD.

Secure mental health services aim to assess and treat mentally disordered offenders, where a patients care pathway involves their movement from service to service on an individual journey towards recovery. Research has attempted to understand the relationship between psychosis and violence for mentally disordered offenders. From this empirical evidence base a tripartite typology has emerged. Three subgroups have been categorised as (i) schizophrenia preceded by conduct disorder (SZ+CD), (ii) offenders with schizophrenia who begin offending at illness onset (SZ+AS), and (iii) offenders with schizophrenia (SZ). This study aimed to examine differences in care pathways between subgroups. The sample consisted of 77 male patients admitted to low- and medium-secure care. The subgroup of patients was determined from data collected from health records. The analysis examined the differences in patient care pathways. The results demonstrated differences in subgroup pathways to, within and from secure services. The SZ+CD subgroup had a higher number of placements used, were more likely to transition between the same level of security, and had an increased use of the private sector. The SZ+AS subgroup was significantly more likely to use intensive care and less likely to use high secure services. Examining care pathways of mentally disordered offenders will ensure a more evidence-based approach to the configuration and operationalisation of services, help guide policymakers and hopefully improve patient care. [ABSTRACT FROM AUTHOR]

Three pathways of antisocial behaviour and psychosis have been described. Three subgroups within a typology have been categorised as (i) schizophrenia preceded by conduct disorder (SZ+CD), (ii) offenders with schizophrenia and no childhood history of antisocial behaviour who begin offending at illness onset (SZ+AS), and (iii) offenders with schizophrenia (SZ). There are no studies investigating how the subgroups utilise services. This study aimed to examine the concurrent validity of typology and examine differences in service utilisation. The sample consisted of 77 male patients admitted to low- and medium-secure units in the United Kingdom. The subgroup of patients was determined from data collected from health records. Analysis assessed the difference in aetiological variables amongst the typology and examined the relationship of subgroup service utilisation. This study provided further evidence of distinguishing characteristics emphasising typology heterogeneity and found differences in service utilisation. The SZ+CD subgroup was more likely to have used services preceding a diagnosis of psychosis. Following the onset of psychosis, the SZ+AS and SZ subgroups had a higher proportion that used general adult psychiatry services. Those patients within the SZ+AS and SZ subgroups had a higher use of general adult services after psychosis onset. Understanding about how these subgroups utilise services will enable clinicians to develop effective management plans that address the distinct characteristics of offenders with psychosis. [ABSTRACT FROM AUTHOR]

In everyday mental health practice, clinicians are expected to assess and manage the risk of harm that may be caused by their patients to others. An informed approach to the activities of risk assessment and management should be grounded in a thorough understanding of the notion of risk. Whilst there are agreed definitions of risk, they do not do justice to the complexity of in-vivo representations of risk. Based on a review of the literature, an analysis of clinical guidelines, and practicing psychiatrists' reflections on their own clinical experiences and sample vignettes, this article explores the varied subjective representations of risk in mental health practice. Of specific relevance to the possibility of an individual causing harm is the need to recognise that the causal agent of harm is an as-yet-unrealised state of consciousness, and that actions that may reduce risk are multiple and have effects that are difficult to define in advance. From an analysis of the semantic context of the use of the word 'risk' within practice guidance, the authors demonstrate a wide range of meanings (including harm, possibility of harm, characteristics of possible harm, a state with changeable potential for harm, and different states of potential harm) with different degrees of embodiment. With reference to clinical scenarios, the formation of individual subjective representations of risk are shown to vary not only in the way they can be characterised (e.g. likelihood, severity, and imminence), but also in the extent to which they come into subjective focus. Uncovering the different ways risk is represented in practice should allow a more refined approach to guiding and studying the process of risk assessment and management. [ABSTRACT FROM AUTHOR]

SUMMARY: Approaches to assessing violence in clinical practice have been influenced by developments in the field of risk assessment. As a result, there has been a focus on identifying and describing factors associated with violence. However, a factor-based approach to assessing violence in individual cases has limited clinical utility. In response, the benefits of a formulation-based approach have been promoted. This approach is enhanced by an understanding of the specific mental mechanisms that increase the likelihood of violence in the individual case. Although there is an empirical evidence base for mental mechanisms associated with violence, this literature has not been distilled and synthesised in a way that informs routine clinical practice. In this article the authors present the key mechanisms that are known to be associated with violence in a way that is relevant to the clinical assessment of violence and, in turn, can inform clinical and risk management. [ABSTRACT FROM AUTHOR]

Violent crime may impact the perpetrator in many ways, such as experiencing the negative emotions of shame and/or guilt. These emotions may subsequently play a role in adjusting to life after the crime has taken place, which is an area that has been relatively under-researched. The review aimed to identify and synthesise all available literature on the experience of offence-related shame and/or guilt in violent offenders, and to describe and characterise the methodological standard of research evidence whilst suggesting areas for further research. A systematic review of relevant databases was conducted using predefined search terms related to 'shame' and/or 'guilt' and 'violent offenders'. A mixed methods systematic review of sample characteristics, methodologies and measures was conducted to describe and compare findings across quantitative and qualitative studies. The review yielded nine papers. Offence-related shame and/or guilt was prevalent among violent populations. Results highlight the complexity and importance of the two emotions for offender rehabilitation. The findings support the need for further investigation to improve the methodological rigor within this area, such as the use of, and development of validated measures of offence-related shame and/or guilt to encourage a more reformed understanding of offence-related shame and/or guilt, for violent offenders. The review considers several implications for research and practice. • Shame and/or guilt are complex emotions and hold important insights into offender rehabilitation. • Approaches should focus on enhancing adaptive guilt, whilst reducing maladaptive shame. • Future research should aim to improve the methodological rigor when exploring shame and/or guilt as offence-related emotions. [ABSTRACT FROM AUTHOR]