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The purpose of this study was to explore the predictive validity of the revised Problem Identification Checklist (PIC‐R) in predicting inpatient and community violence using a retrospective design. The Historical Scale (H‐Scale) of the HCR‐20 was employed to control for static risk factors. The predictive accuracy between predictors and outcome measures was evaluated using Receiver Operating Characteristics (ROC) analysis. The PIC‐R significantly predicted inpatient violence (AUC range 0.77‐0.92) over a 12‐month follow‐up period but did not predict community violence. Conversely, the H‐Scale significantly predicted community violence (AUC 0.82) but did not predict inpatient violence over a 12‐month follow‐up period. The findings offer preliminary validation for the predictive accuracy of the PIC‐R for violence in a UK inpatient population. Additionally, the findings suggest that short‐term risk of violence within a psychiatric inpatient population may be more related to dynamic and clinical risk variables rather than to static ones.

Risk assessment and risk management planning are integral to reducing risk of future violence in forensic settings. Over the past decade, emphasis has been placed on involving service users in this process. Nonetheless, service user knowledge of violence risk assessments such as the Historical-Clinical-Risk Management-20, Version 3 (HCR-20v3) and collaborative risk assessment is often limited. This service evaluation aimed to assess the effectiveness of a pilot Understanding Risk programme, on increasing knowledge of the HCR-20v3 and insight into risk of violence.

The methodology used was a within-subjects design, collecting quantitative data before and after intervention. Participants’ beliefs and attitudes supportive of violence, and perceptions of their recovery, were assessed using a semi-structured HCR-20v3 questionnaire, the Maudsley Violence Questionnaire and the Recovery Assessment Scale – Domains and Stages. An HCR-20v3 historical factor checklist was also completed. The final sample (n = 11) consisted of low and medium secure forensic inpatients.

The results of this study indicated that after intervention, participants had significantly greater knowledge of the HCR-20v3 and more positive perceptions of their functional and personal recovery. Significant changes were not observed on the Maudsley Violence Questionnaire total score; however, further analysis indicated significantly lower scores on the “acceptance of violence” subscale after intervention.

The Understanding Risk programme was associated with positive changes across treatment domains in a small sample of forensic inpatients. Specifically, improvements were observed for increased knowledge of the HCR-20v3, attitudes towards recovery and non-acceptance of violence. It would be of clinical benefit to replicate this study across different levels of security to increase the generalisability of findings. This study shows promise for the efficacy of the Understanding Risk programme among forensic inpatients.

This service evaluation provides preliminary support for the benefits of educating and involving service users in violence risk assessment.

Coercive practices – which are used as means to manage violent/aggressive behaviour in secure forensic settings – have come under scrutiny in recent years due to their paradoxical effects on provoking further service user aggression and violence. Previous research has found relationships between increased service user aggression with both service users’ interpersonal styles and perceptions of staff coercion (i.e. staff limit setting). This paper aims to investigate whether forensic service users’ levels of interpersonal sensitivity to dominance increase levels of self-reported anger and rates of aggression towards staff through perceptions of staff coercion.

In a cross-sectional quantitative study design, 70 service users were recruited from one high and two medium secure forensic hospitals. Standardised measures were completed by service users and recorded incident data was collected within the past year. Correlation and mediation analyses were run to investigate the relationship between study variables.

A significant relationship was found between service users’ interpersonal sensitivity to dominance and self-reported rates of anger, where forensic service users’ who had higher levels of interpersonal sensitivity to others’ dominance were likely to report higher rates of anger. No significant relationships were found between all other study variables.

The findings from this study contradict previous research where coercive practices may not necessarily increase rates of aggression towards staff but, in the context of service users’ interpersonal sensitivities to dominance, it may be more useful to consider the way in which coercive practices are implemented.

There is a gap in the literature, which looks at the way in which forensic service users perceive coercive practices in relation to their interpersonal sensitivities and whether this too has an impact upon service user aggression.

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.

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.

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.

This was an exploratory survey and results should be verified using larger samples.

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.

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.

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.

Official criminal justice statistics (e.g. arrest rates) underestimate the frequency of crime because not all crime gets reported to authorities, a phenomenon known as the “dark figure of crime.” The present study aims to examine the dark figure of violence committed by discharged psychiatric patients.

Multiple reporting modalities permitted a direct comparison between patients whose violence was officially detected to those whose violence was self-reported but not officially detected, along with differences in the nature of violent acts.

Only 5% of violent individuals were officially detected, 26% of violent individuals were both officially detected and self-reported their violent behavior, while 68% of violent individuals self-reported their violent behavior and were not officially detected. The type of violent acts did not vary as a function of whether they were officially detected or self-reported. However, differences were observed for the location of violence, the relationship to the victim and whether an injury resulted. Older individuals, those with prior arrests and those with higher psychopathy scores are some of the factors associated with an increased likelihood of officially detected violence.

The data were collected from three sites in the USA. Generalizing the specific findings to other locations and countries ought to be done cautiously.

Studies ought to include multiple methods to measure violence. Self-report seems to be especially important to the extent one is concerned with measuring actual violence rather than violence that gets detected by legal authorities.

This study highlights an important limitation of relying exclusively on official criminal justice statistics when studying violence or recidivism in the community.

The purpose of this paper is to undertake a systematic literature review to appraise the current evidence relating to the factors associated with violence and aggression in adult psychiatric hospital inpatient settings.

A systematic search of following four databases was conducted: Scopus, PsychINFO Medline, CIHAHL and PsychArticle. Following the application of the inclusion criteria, ten papers were extracted and included in the review. A quality appraisal tool, Mixed Methods Appraisal Tool (MMAT) version 2011 (Pluye et al., 2011), was employed for the appraisal of the qualitative and quantitative studies. MMAT has been designed for systematic literature reviews that include qualitative, quantitative and mixed methods studies. Of these, eight were of quantitative methodology and two were of qualitative studies.

These ten papers provide an insight into factors associated with violence and aggression towards nursing staff. Three main themes were identified: the environment, attitudes/interaction of staff, and the patient’s mental illness. The themes were important factors in the causes of violence but were interlinked highlighting the complex nature of violence towards nursing staff. The findings support the need for training for nursing staff and the development of ongoing support and for organisations to consider both the environment and the restrictive procedures to help reduce violence and aggression towards nursing staff.

The paper concludes by outlining the importance of considering the three main themes for clinical practice, training and development of secure services.

This paper gives insight into the factors associated with patient violence and aggression towards nursing staff in a secure setting.

Forensic health-care workers are frequently exposed to behaviours that challenge and traumatic material, with notably high levels in developmental disorder (DD) services. The provision of support is key in alleviating distress and improving work functioning. This paper aims to incite clarity on whether staff in DD services are more likely to access trauma support. The prevailing needs and outcomes for this population are also explored.

Data was extracted retrospectively from a database held by an internal trauma support service (TSS) for staff working in a secure psychiatric hospital. Overall, 278 permanent clinical staff accessed the TSS between 2018 and 2020, 102 (36.7%) of whom worked in an adult DD forensic inpatient service.

Staff working in DD services were over-represented in referrals to the TSS with a greater number of referrals per bed in DD services than in non-DD services (0.94 vs 0.33). DD staff were comparatively more likely to access support for non-physical, psychologically traumatic experiences. Psychological needs and outcomes following support were comparable between staff across services.

The findings highlight the more frequent need for trauma support of staff in forensic inpatient DD settings. Embedding a culture of safety and openness, and establishing appropriate and responsive models of staff support reflect key priorities for inpatient DD health-care providers, for the universal benefit of the organisation, workforce and service users.

This study offers novel insight into levels of access to support for staff working with people with DDs.

This paper reviews the current issues in risk assessment and risk management facing practitioners, and draws upon current literature to argue for an holistic approach to assessment. The demands of risk management in a climate of risk avoidance are briefly reviewed, and key principles for effective risk management offered.

This paper aims to illustrate by means of a case study how HKT-R Spider reference profiles of recidivists and non-recidivists may be supportive in leave decisions.

The authors describe what is known for recidivists and non-recidivists about changes in risk factors during treatment. The HKT-R Spider is introduced. By comparing a case study to group profiles, the authors illustrate how discussions about leave may be rationalised. From a study among 278 patients to explore the profiles, the authors report the inter agreement, and differences between recidivists and non-recidivists of the clinical HKT-R factors. Intra correlation coefficients, Wilcoxon signed ranks test and independent and paired t-tests are applied. To explore which combination of factors are discriminating between both groups, the authors also performed logistic regression analyses at six treatment stages.

The inter agreement reliability and internal consistency of the clinical HKT-R scale were acceptable to good in all six stages studied. The HKT-R Spider and profiles can be used to assist in evidence-informed decision-making about leave.

Globally recidivists had somewhat higher levels of clinical risk factors at all six decision moments, but the interpretation of HKT-R Spiders profiles should always be adapted to the individual’s context.

Applying the HKT-R Spider reference profiles on individual cases may structure and rationalize discussions lead to decisions based on clinical facts.

Inpatient violence can have a major impact in terms of traumatic experiences for victims and witnesses, an unsafe treatment climate, and high-financial costs. Therefore, the purpose of this paper is to gain more insight into patterns of violent behavior, so that adequate preventive measures can be taken.

Data on inpatient violence in a Dutch forensic psychiatric hospital between 2008 and 2014 were extracted from hospital files on 503 patients.

More than half of all the patients (n=276, 54.9 percent) displayed verbal aggression on at least one occasion, whereas 27.2 percent of all patients (n=137) exhibited one or more incidents of physical violence. Female patients were responsible for more physically violent episodes than male patients. Patients admitted with a civil court order exhibited more violent behavior than patients with a criminal court order. Violent patients with a civil commitment had a significantly longer length of stay than non-violent patients with a civil commitment. More violence was found to take place on the earlier days of the week.

This study points at important differences between groups of forensic inpatients in frequency and type of inpatient violent behavior and in temporal factors. Interventions aimed at reducing the number of violent incidents should take these differences into account. Further research is necessary to gain more insight into the background of inpatient violence.