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The assessment of risk of recidivism in sexual offenders is fundamental to clinical practice. It is widely accepted that, compared with actuarial measures of risk, unaided clinical judgment has generally been found to be of low reliability. Consequently, the literature has shown a surge in actuarial measures. However, a major difficulty in assessing risk in sex offenders is the low base rate, leading to an increased likelihood of making a false positive predictive error. To overcome this, risk assessment studies are increasingly using the receiver operating characteristic (ROC), which displays the relationship between level of risk and decision choice. This note summarises the methodological issues in measuring predictive accuracy in assessing risk of re‐offending in sexual offenders, and identifies from the literature both static and dynamic risk factors associated with sexual offence recidivism.

This critical review considers the limitations and advantages of the clinical, actuarial and structured clinical judgement approaches as they are applied to the assessment of risk in general and sex‐offenders in particular. It concludes by endorsing an inclusive approach, acknowledging that a central ethic of clinical practice is that it should be based on a current knowledge of the research literature (Singer, cited in Douglas et al. 1999).

The present study investigates the use of two actuarial assessment measures ‐ Risk Matrix 2000 (Thornton et al, 2003) and Static 99 (Hanson & Thornton, 2000) ‐ with individuals convicted of downloading child pornography on the internet. A UK community‐based sample of convicted internet sex offenders (n = 73) was assessed using both a standard and a revised version of RM2000 and Static 99 and assessed for rates of reconviction. None of the offenders in the sample were convicted of a further sexual crime between a one‐and‐a‐half and fouryear follow‐up. These results suggest reconviction rates for internet sex offenders are lower than for contact child sex offenders. It was found that both the standard version of RM2000 and Static‐99 overestimate the risk levels posed by internet offenders and that an adapted version of RM2000 may be a more realistic measure of risk level in this population. In addition, it was noted that a higher frequency of low‐risk offenders appeared to be accessing images of younger children and images depicting more serious victimisation than high‐risk offenders.

The aim of this paper is to provide up‐to‐date discussion of the types of factors used to assess sexual offenders risk.

The current status of the factors used to assess risk in sexual offenders is examined.

Risk factors broadly fall into two categories: static factors (i.e. generally unchangeable information such as previous offence history) from which a number of actuarial scales have been developed; and dynamic factors (i.e. psychological dispositions) that are typically identified in treatment. It is suggested that these risk factors are artefacts of the same behavioural and psychological vulnerabilities at different stages of assessment, with static factors acting as markers for underlying dispositions, while dynamic factors are the underlying dispositions.

The paper discusses in some detail the status of age as a risk factor, where even though it is typically considered a static risk factor in a number of actuarial scales (allowance typically being made if individuals are over/under 25), there is a dynamic element (i.e. change with age or the passage of time) to this aspect of assessment.

This paper may be useful to practitioners working in the field, in terms of providing a useful heuristic framework for risk conceptualisation.

The purpose of this paper is to examine empirical, epistemological and conceptual challenges and clinical narratives in the application of risk assessment and management in mental health.

The authors used a narrative review of empirical, conceptual and clinical literature.

The worldwide prevalence of violence in mental health settings remains high. Risk assessment and management approaches, while well intentioned as an attempt to reduce harm and increase people’s safety, have negligible effect on both. They are invariably individual centric, ignore wider environmental, societal and behavioural influences that foment violence and have a stigmatising effect on people using mental health services. They also reinforce the myth that people who are mentally unwell threaten society and that through current risk assessment and management approaches, we can minimise this threat.

There is a need to reconsider the study and application of violence risk assessment in mental health.

The practice of risk assessment and management in mental health is marred by an overuse of risk assessment measures that are limited in their predictive efficacy. As a result, they have little value in preventing, reducing and/or managing harm. The language of risk punishes and stigmatises service users and reinforces the image of menace. An alternative language of safety may nourish and protect. A collaborative approach to safety assessment based upon recovery-focussed principles and practices may fuse professionals and service users’ horizons. Combining service users’ self-perception, professionals’ sound clinical judgement, assisted by electronically derived risk algorithms and followed by evidence-based risk management interventions, may lessen the threat to service users, reduce harm and transform the practice of violence risk assessment and management.

Risk appraisals discriminate against the small number of people who have a mental illness and are risky, an example of preventive detention that is ethically questionable. On the basis of the limitations of the predictive efficacy of actuarial measures, it is ethically dubious to subject people to interventions with limited benefits. Risk assessment processes tend to reinforce stigma by classifying individuals as risky, sanctioning society’s prejudices and fear through scientific authority.

The increasing focus on risk assessment and management to tackle violence in mental health is fraught with empirical, conceptual and practical concerns; the authors have suggested ways in which these concerns can be addressed without compromising people’s safety.

Evidence has shown associations between personality disorder (PD) and poor treatment outcomes. The purpose of this paper is to: first, establish which risk assessment method (i.e. structured professional judgement or actuarial) is most reliable for predicting treatment outcomes for individuals with PD. Second, determine whether individuals identified as high risk are more likely to have poorer treatment outcomes. Third, determine if engagement in treatment helps to reduce risk assessment scores.

In total, 50 patients were recruited from a medium secure forensic PD service. Their risk was assessed using one structured professional judgement instrument (the HCR-20) and one actuarial instrument (the RM2000). The study used a retrospective cohort design.

Overall, the HCR-20 was a better predictor of treatment outcome than the RM2000. Personality-disordered offenders with high HCR-20 scores are at an increased risk of adverse treatment outcomes.

This investigation used a small, non-randomised sample of male patients with PD at one South East England medium secure unit. The data were over-represented by white British males. Future research should compare PD offenders with non-PD offenders to investigate what factors best predict poorer treatment outcomes.

The findings indicate that structured professional judgement approaches are more effective predictors of risk than actuarial measures for assessing patients with PD. This study therefore adds value to forensic services and to the risk assessment debate.

The purpose of this paper is to explore the violence risk assessment practices in Israel by social workers, clinical criminologists, and marriage and family therapists using a Web-based survey.

A Web-based survey and participation letter were translated into Hebrew and distributed to members of the Israel Association of Social Workers, the Israel Society of Clinical Criminology and the Israel Association for Marital and Family Therapy following the Dillman Total Design Survey Method.

The sample was composed of 34 professionals, who reported using structured instruments to predict and manage the likelihood of violence in over half of their risk assessments over both their lifetime and the past 12 months. Younger female respondents who entered their profession more recently were more likely to use instruments during the risk assessment process. There appeared to be a trend toward decreased use of actuarial instruments and increased use in structured professional judgment instruments.

The first national survey of violence risk assessment practices by behavioral healthcare professionals in Israel was conducted. This study revealed the risk assessment utility trends in Israel, finding that compared to professionals in North America, South America, Europe, East Asia and Australia, professionals in Israel conducted fewer risk assessments and used structured instruments less often, highlighting concern about the lack of reliance on evidence-based techniques in the country.

The England and Wales National Health Service (NHS) Executive's guidance on the discharge of mentally disordered people, including those with learning disabilities, requires that risk assessment is a component part of the Care Programme Approach (CPA). The guidance indicates that whenever possible, risk assessments should be carried out systematically using a standardised approach. For a number of reasons, practitioners are resistant to moving away from reliance on clinical judgements when making their assessments. This paper explores the issues underlying this tension. A solution is offered to the difficulty clinicians often experience in incorporating risk assessment tools into their clinical practice. A case example is given to illustrate how clinical assessments of offenders with learning disabilities can be utilised to estimate the risks presented. By demonstrating this procedure, a protocol for reaching clinically defensible decisions about the risks presented by clients is described, which also allows for the targeting of priority therapeutic and management interventions.

The purpose of this paper is to examine the extent to which risk is addressed in the risk management planning process of those convicted of sexual offending.

Data were collected from a risk assessment and management system called the Offender Assessment System (OASys), used by the National Offender Management Service, in England and Wales. The records of 216 clients were accessed and each risk management plan analysed. The study aimed to understand if first, general and sexual risk factors identified by assessors were recorded and detailed in subsequent plans; second, if specialist sexual offending risk assessment tools were used to inform risk management strategies; and third, if both a balance of control and support mechanisms were in place to tackle identified risk and needs of clients.

Inconsistencies were found in relation to practitioners transposing risks identified, into the subsequent risk management plans. Strategies were therefore deemed, inadequate as there was a significant omission of the use of specialist sexual risk assessment tools to inform and ensure risk assessment to be robust. In addition risk management plans were often overbearing in nature, as assessors tended to utilise control strategies to assist the reintegration process, in contrast to a combination of both control and support.

This sample was taken from only one probation trust in England and Wales. The findings might therefore be unique to this organisation rather than be representative of national practice. This study should therefore, be replicated in a number of other probation areas. In addition, it is important to note that this study only reviewed one electronic tool used by practitioners. Therefore, while it might appear for example that the RM2000 tool was not routinely completed; this cannot be assumed as practitioners might have adopted local custom and practice, recording RM2000 scores elsewhere.

These findings highlight the need for some understanding as to why there is a lack of consistency throughout the risk management planning process. Practitioners should receive ongoing risk management training, development and supportive supervision. In particular, practitioners require supervision that supports and develops their skills when applying RM2000 classifications to their clients’ risk management plans. Likewise initiatives which develop practitioner’s awareness and application of strengths based approaches such as the Good Lives Model should be encouraged. These will help practitioners develop plans that address both the risks while supporting their development of the strengths a client presents.

To the authors’ knowledge, this is the first study of its kind, which examines the risk management plans of those convicted of sexual offending, completed by practitioners in England and Wales using the OASys tool.