The utility of the Historical Clinical Risk -20 Scale as a predictor of outcomes in decisions to transfer patients from high to lower levels of security-A UK perspective

Abstract

BackgroundStructured Professional Judgment (SPJ) approaches to violence risk assessment are increasingly being adopted into clinical practice in international forensic settings. The aim of this study was to examine the predictive validity of the Historical Clinical Risk -20 (HCR-20) violence risk assessment scale for outcome following transfers from high to medium security in a United Kingdom setting.MethodsThe sample was predominately male and mentally ill and the majority of cases were detained under the criminal section of the Mental Health Act (1986). The HCR-20 was rated based on detailed case file information on 72 cases transferred from high to medium security. Outcomes were examined, independent of risk score, and cases were classed as "success or failure" based on established criteria.ResultsThe mean length of follow up was 6 years. The total HCR-20 score was a robust predictor of failure at lower levels of security and return to high security. The Clinical and Risk management items contributed most to predictive accuracy.ConclusionsAlthough the HCR-20 was designed as a violence risk prediction tool our findings suggest it has potential utility in decisions to transfer patients from high to lower levels of security.

Factors Associated with Recommitment of NGRI Acquittees to a Forensic Hospital

“…Results also correspond to the findings by Dolan and Khawaja () that, among the three scales of the HCR‐20, the Historical scale best predicted recommitment and violent reoffending among forensic patients discharged from medium security settings over a two year follow‐up period. However, results differed from those reported by Dolan and Blattner (), who observed that scores on the Historical scale did not differentiate recommitted or reconvicted forensic patients from those who successfully transferred from a medium security facility. Patients in the latter study and current study presented similar numbers of risk factors, as the mean scores on the Historical scale were equivalent.…”

“…Dolan and Khawaja () reported that elevated scores on these scales are correlated with revocation of release among forensic psychiatric patients. Furthermore, Dolan and Blattner () reported that total scores and scores on the Clinical and Risk Management scales differentiated mentally ill offenders who were recommitted to a high security psychiatric facility following transfer to a medium security facility from those who were not recommitted. Patients were “at risk” of recommitment for an average of six years; however, whether the scales differed in their predictive validity over time was not reported.…”

Prospective in-patient cohort study of moves between levels of therapeutic security: the DUNDRUM-1 triage security, DUNDRUM-3 programme completion and DUNDRUM-4 recovery scales and the HCR-20

“…Because the HCR-20 is established as a predictor of moves and recalls [5-8], we hypothesised that any other measure would have to have a significant effect even when correcting for HCR-20 dynamic risk. We further hypothesised that the risk of violence or self-harm, combined with the seriousness of the risk, would be significant determinants of the decisions to move patients, based on the original formulation of Scott concerning risk and the seriousness of the risk [11].…”

Risk Assessment: A Reflection on the Principles of Tools to Help Manage Risk of Violence in Mental Health

“…A study of forensic psychiatric patients released into the community found correlations between final risk judgements and future community violence (Douglas et al, 2003). Correlations between clinical and risk management factor subscales and institutional violence were found in a sample of prisoners (Belfrage, Fransson, & Strand, 2000) and a more recent study (Dolan & Blattner, 2010) found that HCR-20 scores were a robust predictor of failure following transfer from a high to a medium secure unit in the United Kingdom.…”