Psych · Forensic psychiatry — risk assessment
Risk assessment in forensic settings
Also known as Forensic violence risk assessment · HCR-20 forensic · Structured professional judgement forensic · Actuarial risk assessment forensic · VRAG · Static-99R · SAPROF protective factors · Forensic risk formulation · Secure hospital risk assessment · Release risk assessment
Exam-exhaustive fellowship reference on risk assessment in forensic settings — UCJ vs actuarial vs SPJ; HCR-20 conceptual domains; formulation and scenarios; protective factors (SAPROF concepts); institutional vs community horizons; light sexual-offending pointer; RNR; multi-agency public protection principles; forensic report structure. Distinct from emergency violence-risk imminence. FRANZCP-primary, globally tagged.
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- Named community victim with access during leave or step-down — treat as high dynamic risk until victim access, means, and supervision are secured
- Rising institutional aggression scores (DASA/START-style) with staff-targeted ideation — escalate observation and staffing before seclusion
- Substance relapse immediately before leave or conditional release — cancel or restructure leave; reassess dynamic risk
- Fixated threat with planning and weapons history despite low actuarial score — formulation overrides false reassurance from a single tool
- Sexual risk review with new victim access or supervision breakdown — do not rely on static score alone; reassess dynamic and protective factors
- Incomplete file (missing index offence brief) for a court or tribunal report — do not finalise opinion until primary sources are reviewed
Meet the patient
A 38-year-old man with treatment-resistant schizophrenia and an alcohol use disorder is twelve months into a medium-secure admission after a serious assault carried out in the setting of untreated persecutory delusions. His psychosis has remitted on clozapine. The tribunal has asked you: is escorted community leave safe to begin, and what conditions should attach?[7][18]
Two exam questions are live. Which tool matches this decision? and what does the plan say will happen if he drinks again? Everything below is the consultant-depth answer to both.[8][9]
References20ShowHide
- [1]Fazel S, Singh JP, Doll H, et al. Use of risk assessment instruments to predict violence and antisocial behaviour in 73 samples involving 24 827 people: systematic review and meta-analysis BMJ, 2012.PMID 22833604
- [2]Singh JP, Grann M, Fazel S A comparative study of violence risk assessment tools: a systematic review and metaregression analysis of 68 studies involving 25,980 participants Clin Psychol Rev, 2011.PMID 21255891
- [3]Yang M, Wong SC, Coid J The efficacy of violence prediction: a meta-analytic comparison of nine risk assessment tools Psychol Bull, 2010.PMID 20804235
- [4]Buchanan A Risk of violence by psychiatric patients: beyond the "actuarial versus clinical" assessment debate Psychiatr Serv, 2008.PMID 18245161
- [5]Large MM, Ryan CJ, Nielssen OB Helpful and unhelpful risk assessment practices Psychiatr Serv, 2010.PMID 20439381
- [6]Large MM, Ryan CJ, Singh SP, et al. The predictive value of risk categorization in schizophrenia Harv Rev Psychiatry, 2011.PMID 21250894
- [7]Chen Y, Douglas KS, Zhang Z, et al. Evaluating the HCR-20(V3) violence risk assessment measure with mentally disordered offenders and civil psychiatric patients Behav Sci Law, 2023.PMID 36893019
- [8]de Vogel V, De Beuf T, Shepherd S, et al. Violence Risk Assessment with the HCR-20(V3) in Legal Contexts: A Critical Reflection J Pers Assess, 2022.PMID 35061555
- [9]De Vries Robbé M, de Vogel V, Douglas KS, et al. Changes in dynamic risk and protective factors for violence during inpatient forensic psychiatric treatment: predicting reductions in postdischarge community recidivism Law Hum Behav, 2015.PMID 24933171
- [10]de Vries Robbé M, de Vogel V, Koster K, et al. Assessing protective factors for sexually violent offending with the SAPROF Sex Abuse, 2015.PMID 25210106
- [11]Hanson RK, Morton-Bourgon KE The accuracy of recidivism risk assessments for sexual offenders: a meta-analysis of 118 prediction studies Psychol Assess, 2009.PMID 19290762
- [12]Hanson RK, Thornton D, Helmus LM, et al. What Sexual Recidivism Rates Are Associated With Static-99R and Static-2002R Scores? Sex Abuse, 2016.PMID 25810478
- [13]Gregório Hertz P, Eher R, Etzler S, et al. Cross-Validation of the Revised Version of the Violence Risk Appraisal Guide (VRAG-R) in a Sample of Individuals Convicted of Sexual Offenses Sex Abuse, 2021.PMID 31010400
- [14]Dyck HL, Campbell MA, Wershler JL Real-world use of the risk-need-responsivity model and the level of service/case management inventory with community-supervised offenders Law Hum Behav, 2018.PMID 29620397
- [15]Storey JE, Watt KA, Hart SD An examination of violence risk communication in practice using a structured professional judgment framework Behav Sci Law, 2015.PMID 25615811
- [16]Ogloff JR, Daffern M The dynamic appraisal of situational aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients Behav Sci Law, 2006.PMID 17171770
- [17]Cartwright JK, Desmarais SL, Hazel J, et al. Predictive validity of HCR-20, START, and static-99R assessments in predicting institutional aggression among sexual offenders Law Hum Behav, 2018.PMID 28857580
- [18]Witt K, van Dorn R, Fazel S Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies PLoS One, 2013.PMID 23418482
- [19]Fazel S, Gulati G, Linsell L, et al. Schizophrenia and violence: systematic review and meta-analysis PLoS Med, 2009.PMID 19668362
- [20]Pollak C, Palmstierna T Reducing Risk for Future Violence From Forensic Psychiatric Patients by Using Critical Factors of the Short-Term Assessment of Risk and Treatability as a Caring Tool J Forensic Nurs, 2024.PMID 38048491