Karin Arbach-Lucioni

International Perspectives on the Practical Application of Violence Risk Assessment: A Global Survey of 44 Countries

Mental health professionals are routinely called upon to assess the risk of violence presented by their patients. Prior surveys of risk assessment methods have been largely circumscribed to individual countries and have not compared the practices of different professional disciplines. Therefore, a Web-based survey was developed to examine methods of violence risk assessment across six continents, and to compare the perceived utility of these methods by psychologists, psychiatrists, and nurses. The survey was translated into nine languages and distributed to members of 59 national and international organizations. Surveys were completed by 2135 respondents from 44 countries. Respondents in all six continents reported using instruments to assess, manage, and monitor violence risk, with over half of risk assessments in the past 12 months conducted using such an instrument. Respondents in Asia and South America reported conducting fewer structured assessments, and psychologists reported using instruments more than psychiatrists or nurses. Feedback regarding outcomes was not common: respondents who conducted structured risk assessments reported receiving feedback on accuracy in under 40% of cases, and those who used instruments to develop management plans reported feedback on whether plans were implemented in under 50% of cases. When information on the latter was obtained, risk management plans were not implemented in over a third of cases. Results suggest that violence risk assessment is a global phenomenon, as is the use of instruments to assist in this task. Improved feedback following risk assessments and the development of risk management plans could improve the efficacy of health services.

RISK FACTORS FOR VIOLENT BEHAVIOR IN PRISON INMATES A Cross-Cultural Contribution

A large body of research has focused on indicators of the risk of prison violence, especially in the United States. Little is known about this question in Spain, despite the fact that in 2010, this country had the most crowded prison system in western Europe. This prospective study draws on official data to examine the relationship between individual and situational characteristics and misconduct in a sample of 1,330 inmates from 11 penitentiary facilities across a 10-month period. Violent misconduct was less frequent than potentially violent behavior, with prevalence rates of 9% and 13%, respectively. Younger age, being on remand, classification as first degree, prior violent behavior, drug and/or alcohol problems, poor response to treatment, and procriminal attitudes were significant risk factors of inmate misbehavior in an ordinal regression model (areas under the curve = 0.74 to 0.82). Having a violent conviction offense was not a significant predictor of outcome. The implications for current classification practices are discussed, and the importance of cross-cultural and empirically based research is stressed.

Predicting violence in psychiatric inpatients: a prospective study with the HCR-20 violence risk assessment scheme

This prospective longitudinal study explores the predictive validity of the HCR-20 and the Psychopathy Checklist: Screening Version (PCL:SV) in a mentally disordered high-risk population. Files of 78 inpatients were coded and patients were followed up while in hospital for 12 months by nursing staff who recorded violent incidents using the Modified Overt Aggression Scale. Receiver operating characteristic analyses yielded moderate to strong associations between HCR-20 and violence (AUCs = .69–.77). PCL:SV AUCs were lower and more unstable (.61–.70). Regression analyses revealed that both tools were good violence predictors in the short-term, but only HCR-20 and particularly the clinical subscale contributed to prediction beyond this period. Patients scoring above the HCR-20 mean were 2.1–2.5 times more likely to be violent than those scoring below the mean. The results suggest that the HCR-20s Spanish adaptation is a useful tool for predicting the likelihood of inpatient violence in civil psychiatric wards. Implications for risk assessment research are discussed.

Violence Risk Assessment Practices in Denmark: A Multidisciplinary National Survey

Abstract With a quadrupling of forensic psychiatric patients in Denmark over the past 20 years, focus on violence risk assessment practices across the country has increased. However, information is lacking regarding Danish risk assessment practice across professional disciplines and clinical settings; little is known about how violence risk assessments are conducted, which instruments are used for what purposes, and how mental health professionals rate their utility and costs. As part of a global survey exploring the application of violence risk assessment across 44 countries, the current study investigated Danish practice across several professional disciplines and settings in which forensic and high-risk mental health patients are assessed and treated. In total, 125 mental health professionals across the country completed the survey. The five instruments that respondents reported most commonly using for risk assessment, risk management planning and risk monitoring were Broset, HCR-20, the START, the PCL-R, and the PCL:SV. Whereas the HCR-20 was rated highest in usefulness for risk assessment, the START was rated most useful for risk management and risk monitoring. No significant differences in utility were observed across professional groups. Unstructured clinical judgments were reported to be faster but more expensive to conduct than using a risk assessment instrument. Implications for clinical practice are discussed.