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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 study examined the ability of the HCR‐20 Scale (version 2) to predict incidents of in‐patient violence during a stay on a medium secure ward. The study was carried out retrospectively on a sample of 94 admissions, using reports pre‐existing at the time of admission and nursing observations of behaviour in the two weeks that followed admission. The sample group was made up of mentally disordered offenders and patients with challenging behaviour. Their episodes of care averaged two years.The H and C scores, singly or combined, did not show powerful predictive capacity for the sample as a whole, which had a high base rate for violence. Insufficient variance and poor inter‐rater reliability precluded use of the R variable. For purposes of analysis, violent patients were also grouped on the number of incidents committed during their episode of care. Here the C Scale items showed strong predictive capacity for patients with more than 10 incidents during their stay. The paper argues that the latter finding supports a method of predicting admissions at risk of frequent incidents of violence.

The classification of criminal acts as violent or nonviolent should be a keystone of actuarial predictors of violent recidivism, as it affects their outcome measure and scoring of criminal history, thus influencing many decisions about sentencing, release and treatment allocation. Examination of existing actuarial and clinical violence risk assessment tools and research studies reveals considerable variation in the classifications used. This paper aims to use large samples to develop an alternative, empirically grounded classification that can be used to improve actuarial predictive scores within the offender assessment system (OASys), the tool used by the National Offender Management Service of England and Wales to assess static and dynamic risk.

Two analytical steps are implemented. First, to identify offences that frequently involve violent acts, 230,334 OASys cases are analyzed for indicators of violent content. Second, the ability of dynamic and static risk factors to predict reoffending for various offence types is investigated, analyzing 26,619 OASys cases that have official recidivism data.

The resulting empirical classification of violent offences adds public order, criminal damage, threats/harassment, robbery/aggravated burglary and weapon possession offences to the central group of homicide and assault offences. The need to assess risk of sexual recidivism separately is discussed.

This study has successfully produced an offence classification for use in a new predictor of violent recidivism. The use of empirical methods to select these offences helps to maximise predictive validity.

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 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.

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.

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.

Empirical research concerning the reliability and predictive validity of the juvenile psychopathy construct, as assessed by the Psychopathy Checklist: Youth Version (PCL: YV; Forth et al, 2003) is reviewed. The results of an updated meta‐analysis (k = 38) investigating the interrater reliability of the PCL: YV are presented, along with an examination of meta‐analytic findings on the predictive accuracy of the tool. Considerations with respect to gender, ethnicity and development are explored. Some discussion points are offered regarding potential clinical applications of the construct of juvenile psychopathy and the PCL: YV with violent and other criminally adjudicated youths.

Sibling violence is generally considered to be the most prevalent form of family violence. This paper aims to examine the association between sibling violence and other forms of violence: parent‐to‐parent violence, parent‐to‐child violence and dating violence.

Data were collected from 590 Portuguese university students.

There was a strong positive association between sibling violence and other forms of family violence. Psychological and physical aggression is highly prevalent among siblings. Results also show that sibling violence is the most prevalent form of family violence. Regression models demonstrated that parent‐to‐child violence is a substantial predictor of sibling violence.

The results of this study point to the importance of studying the co‐occurrence of different forms of family violence.

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.