Forensic risk assessment for leave and step-down (MEQ)

(i) SPJ structure. Multi-source review: index offence brief, prior convictions, hospital notes, collateral, MSE. Apply HCR-style domains — Historical (violence history, mental illness, substances, supervision failure), Clinical (insight, residual symptoms, violent ideation, stability, treatment response), Risk management (leave plan feasibility, destabilisers, supports, compliance, stress). Integrate into formulation and scenarios rather than a single number. Parallel suicide/vulnerability assessment. Jurisdiction-specific legal status noted as principles only.^[1][2][5]

(ii) Factors. Static: male, two prior assaults, index wounding, long-standing schizophrenia. Dynamic (improved): treated psychosis, better insight, negative UDS 4 months, engagement. Residual dynamic risks: neighbour as possible target, substances if leave unsupervised, stress of community exposure. Protective: treatment response, motivation, professional care, structured leave supports if arranged, abstinence so far. Gains in dynamic and protective factors support cautious step-down testing despite high static load.^[3]

(iii) Actuarial role/limits. Actuarial tools may rank group risk using fixed historical items; elevated static ranking is expected given prior violence. Meta-analyses show only moderate group accuracy and limited individual certainty. Actuarial scores do not write a leave plan and should not veto all progress when dynamic and protective factors improve — nor should low scores override clear current threat. Use as adjunct within SPJ formulation.^[1][4][6]

(iv) Scenarios and plan. Scenario A: assault on neighbour if unescorted leave + persecutory relapse + unsupervised contact. Scenario B: public aggression if methamphetamine relapse on leave. Plan: graduated escorted leave first; no contact with neighbour; UDS before leave; confirm medication adherence; crisis contact; suspend leave if substances or symptoms return; multi-agency communication if community risk escalates; review date set. Document who/what/when/prevention — not only "medium risk".^[2][5][6]

(v) Report elements. Instructions/questions; sources (and gaps); background and index offence; history and treatment response; MSE; method (SPJ ± actuarial adjunct); formulation and scenarios; opinion on leave with reasoning; recommendations (conditions); limitations and reassessment triggers.^[2][5][6]