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The purpose of this paper is to explore two distinct yet complimentary “structured professional judgement (SPJ)” approaches to terrorist/extremist risk assessment on the vexing issue of how best to deal with the subjectivity inherently involved in professional judgement.

An SPJ methodology is considered the best practice approach for assessing terrorism risk. Currently there are four specific terrorism risk instruments that have been published in the literature. Two of these SPJ tools are examined in detail, namely the Violent Extremist Risk Assessment tool (Pressman, 2009; Pressman et al., 2012) and the Structured Assessment of Violent Extremism (SAVE) tool (Dean, 2014). The paper critically unpacks the conceptual and methodological stumbling blocks of an SPJ methodology for controlling human subjectivity.

The paper presents the case for adopting a “controlling in” approach rather than a “controlling out” approach of an analyst’s subjective tacit (in-the-head) knowledge inherent in their professional judgement. To have a quantifiable SPJ tool that triangulates the multi-dimensionality of terrorism risk which can validate an analyst’s professional judgement is the next logical step in terrorist/extremist risk assessment work. The paper includes a case example of this “controlling in” approach and the validation methodology used by the SAVE software system.

The implications for practice range from incorporating the SAVE system in operational policing/national security work with its quantitative nature, triangulated risk scores, visualisation output of a prioritised case report with in-built alerts, to the required training for system calibration to enhance user proficiency.

This is a highly original and innovative paper as this type of quantified SPJ tool (SAVE) has up until now never been applied before in terrorist/extremist risk assessment work.

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 outline the process of risk assessment for terrorists and violent political extremists and to present an example of such an approach. The approach proposed is referred to as the VERA 2 or violent extremism risk assessment protocol (Consultative Version 2).

A review of the knowledge base relating to risk assessment and risk assessment methodology was undertaken with a focus on relevance to individual terrorists and violent extremists. The need for a specific approach for the risk assessment of terrorists that differs from approaches used for ordinary violent criminals was identified. A model that could be used for the risk assessment of terrorists was identified with pertinent risk indicators. This was structured into a protocol referred to as the VERA (Consultative Version 2). The approach is intended to be applied to different types of violent extremists, terrorists and unlawful violent offenders motivated by religious, political or social ideologies.

First, risk assessments of adjudicated terrorists and violent extremists should be undertaken with risk indicators that are relevant to ideological motivated violence. Indicators used for ordinary common violence differ in substantive ways from those relevant to terrorists and therefore may have questionable relevance for the assessment of risk in terrorists. Second, it is possible to construct an evidence‐based risk assessment approach for the range of violent extremists and terrorists using a structured professional judgment approach with pertinent risk indicators. The VERA 2 is an example of this type of risk assessment protocol for terrorists and unlawful violent extremists.

Risk assessment tools that have been developed for ordinary violent criminals and members of organised criminal gangs should be used with caution with terrorists, violent extremists and other perpetrators of ideologically motivated unlawful violence. Specific risk assessment approaches for terrorists with relevant indicators should be used. At this time, terrorist oriented approaches such as the VERA 2 are to be considered consultative and used as an add‐on to other established approaches.

There are few transparent, structured risk assessment approaches that use indicators specifically relevant to violent political extremists and terrorists. One new approach, the VERA 2 is outlined in the paper using risk indicators that differ in substantive ways from those used for other ordinary violent criminals.

The Central Mental Hospital in Ireland is one of the oldest forensic mental health units in Europe. The hospital is currently in the process of transforming from a single inpatient site to a modern national forensic mental health service. Central to this transformation is the need to move from the traditional security‐focused model of care to a model of recovery. The challenge incumbent within this transformation is to incorporate a sophisticated amalgamation of the patients' needs while recognising the broad range of security requirements in a forensic setting. This paper considered that adopting an integrated care pathway (ICP) approach would provide the service with a vehicle to re‐engineer our principles and systems of care. Likewise we hypothesised that the ICP would enable us to consolidate best practices such as multi‐ disciplinary working, structured professional judgement and the involvement of the patient and their carers. Thus far it has afforded us the opportunity to examine many aspects of the care delivered within the service. It has provided a shared understanding of key standards among clinicians, service users and carers that are necessary to implement a quality care pathway. It has certainly not been a stagnant process, and the initial work often bears no resemblance to the current process. In turn, we expect that it will continue to change as the path travelled is as important as the outcome and the ICP becomes a dynamic part of the organisation.

Criteria to determine in which level of security forensic patients should receive treatment are currently non-existent in Belgium. Research regarding the assessment of security level is minimal and few instruments are available. The DUNDRUM toolkit is a structured clinical judgement instrument that can be used to provide support when determining security level. The purpose of this paper is to investigate the applicability and validity of the DUNDRUM-1 in Flanders.

The DUNDRUM-1 was scored for 50 male patients admitted at the forensic units in the public psychiatric hospital Rekem. Some files were rated by three researchers who were blind to participants’ security status, resulting in 33 double measurements.

Almost all files (96 per cent) contained enough information to score the DUNDRUM-1. Average DUNDRUM-1 final judgement scores were concordant with a medium security profile. No difference was found between the current security levels and the DUNDRUM-1 final judgement scores. Inter-rater reliability was excellent for the DUNDRUM-1 final judgement scores. On item level, all items had excellent to good inter-rater reliability with the exception of one item institutional behaviour which had an average inter-rater reliability.

The DUNDRUM-1 can be a useful tool in Flemish forensic settings. It has good psychometric properties. More research is needed to investigate the relationship between DUNDRUM-1 scores and security level decisions by the courts.

This is the first study that investigated the applicability of the DUNDRUM-1 in a Belgian setting, also a relative large number of repeated measurements were available to investigate the inter-rater reliability of the DUNDRUM-1.

There are a limited number of risk assessment tools relevant to the internet child abuse material (I/CAM) offender cohort. The purpose of this paper is to introduce a new tool, the “Estimated Risk for Internet Child Sexual Offending” (ERICSO). The ERICSO has been developed to assist in the treatment and prevention of sexual crimes against children.

The ERICSO was developed through a multi-stage process including systematic review, survey of professionals and offender case study.

An empirically guided tool for estimating risk for I/CAM offenders, the ERICSO is composed of four domains. The Demographic domain questions provide information about the offender, while Collection domain questions address the content of the offender’s files. The Nature of Engagement domain considers the offender’s interaction with I/CAM, behavioural aspects and contact with children. The Social Aspect domain questions address the offender’s engagement with other I/CAM users. Finally, the assessor may use Structured Professional Judgement to provide additional information, and a summary of the offender’s relevant circumstances and a risk estimation.

The ERICSO provides guidance for the assessment of I/CAM offenders who may reoffend with online child sexual offences, and I/CAM offenders who may reoffend with contact child sexual offences.

Born from a history of generational attitudes towards rehabilitation and risk assessment, the launch of the ERICSO presents an exciting opportunity in the risk estimation of I/CAM offenders.

This paper is based on seminar, workshop and lecture materials presented at national and international conferences, and follows an invitation to cover this topic as part of a one‐day conference on mental health issues in autism spectrum disorders (Staufenberg, 2005; 2007). The paper will seek to a) outline a review of the current evidence base and clinical approaches to the appraisal of risk behaviour or aggressive conduct in general and forensic psychiatric practice, before b) reviewing the current issues in the clinical risk appraisal in individuals with complex neurodevelopmental syndromes of the high functioning autism spectrum, and in particular Asperger's syndrome.References based on clinical and structured instrument‐based risk appraisal will also introduce the pertinence of assessing personality traits in individuals with Asperger's syndrome, with specific reference to forensic neuropsychiatry‐based expertise and case vignettes. A discussion of potential research directions and collaborations will conclude this introductory guide to the emerging field of forensic developmental neuropsychiatry.

The purpose of this paper is to identify what key factors multi-disciplinary teams (MDT) deem as most important when making the decision to move service users from one level of security (including low, medium and high secure services) to another. The researchers used the findings from this study to further develop a tool; the assessment for level of security tool (ALS), which aims to structure and streamline this decision-making process.

Data from 18 interviews (MDT staff) were analysed using the Delphi technique (Dalkey and Helmer, 1963). This revealed a range of factors discussed when considering service users moves. Participants were asked to rate these factors in accordance with the Delphi which resulted in the removal of certain less important factors based on their scores. The researchers then compared these factors of relevance with a checklist of 16 items previously proposed by a consultant psychiatrist within the trust. This comparison allowed the researchers to highlight any similarities and differences present.

Findings from staff interviews revealed a range of 20 clinical factors perceived as essential to this process including procedural, relational and physical security aspects. However, variations were evident between the MDT priorities (20 items) and the originally proposed list. This emphasised the need for a tool which facilitates a holistic and streamlined approach.

The findings from this research have resulted in the development of the ALS tool comprising of 18 key factors.

It is envisaged the development of the ALS tool will not only facilitate and structure the decision-making process but also ensure a person-centred approach. This is because the ALS allows for a holistic approach based on an array of factors deemed important to that particular service user. Furthermore, the ALS tool contributes towards the paucity of published structured professional judgement tools needed to make such decisions.

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.