Structured risk assessment in community forensic mental health practice.

Objective: This paper will examine the use of the Historical Clinical Risk Management-20 (HCR-20) by Australian community forensic mental health services (CFMHS) and explore some key issues involved in the application of Structured Professional Judgment (SPJ) risk assessment tools in clinical practice. Method: We used a survey of the use of the HCR-20 by 10 Australian CFMHSs. Results: During the 12-month survey period, the number of assessments conducted ranged from 6 to 186 (median 55). Differences in service models impacted on who was seen, whether reassessments were undertaken, and involvement of generalist mental health staff. Most services employed quality assurance processes and accessed qualified trainers. Conclusion: The use of SPJ tools acknowledges the role of professional judgment while also providing a structure to ensure that relevant evidence-based factors are taken into account. The survey highlighted service model variation as well as the importance of training and quality assurance processes required to ensure that comprehensive violence risk assessments are completed in a valid and reliable fashion.