Risk assessment instruments in clinical practice

Can J Psychiatry. 2012 Apr;57(4):238-44. doi: 10.1177/070674371205700407.


Objective: To determine whether the items in one of the most widely validated instruments of violence risk assessment, the Historical-Clinical-Risk Management-20 (HCR-20), are used in review board hearings to assess the risk of violence by people found Not Criminally Responsible on account of Mental Disorder (NCRMD).

Method: This study was conducted from October 2004 to August 2006 in Quebec's sole forensic psychiatric hospital and 2 large civil psychiatric hospitals designated for the care of people declared NCRMD in the Montreal metropolitan area. The risk assessments presented by clinicians at annual review board hearings and the boards' rationale for the release or detention of people found NCRMD were contrasted with the risk assessments conducted by the research team using the HCR-20. The final sample was comprised of 96 men.

Results: Very few of the risk factors identified by prior research (HCR-20 items) were mentioned in the hearing process, whether in clinical reports, discussions during the hearing, or in the disposition justification.

Conclusions: The findings confirm that there remains a significant gap between research evidence and risk assessment practice.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Commitment of Mentally Ill / legislation & jurisprudence
  • Forensic Psychiatry
  • Hospitals, Psychiatric / statistics & numerical data
  • Humans
  • Insanity Defense / statistics & numerical data*
  • Male
  • Mental Competency / legislation & jurisprudence
  • Mental Competency / psychology
  • Mental Disorders / psychology
  • Mentally Ill Persons* / legislation & jurisprudence
  • Mentally Ill Persons* / psychology
  • Middle Aged
  • Patient Advocacy
  • Patient Discharge / legislation & jurisprudence*
  • Quebec
  • Risk Assessment / methods*
  • Risk Factors
  • Violence* / prevention & control
  • Violence* / psychology
  • Violence* / statistics & numerical data