Use of the Historical, Clinical, Risk Management-20 to assess the risk of violence by discharged psychiatric patients.

Priority follow-up (PFU) is provided to patients with poor mental health and a history of criminal violence or disposition to violence. The PFU status of a patient is categorised as non-PFU, PFU-target, and PFU-subtarget (most dangerous) and regularly reviewed by the treating team using unstructured clinical judgement, which may not be accurate or consistent. Structured professional judgement is more useful; it bridges the gap between the actuarial approach and clinical practice for risk assessment. The Historical, Clinical, Risk Management-20 (HCR20)1 is a guideline developed by forensic clinicians for mental health professionals to identify risk factors that are amendable to clinical intervention and to develop individualised risk management strategies. The HCR-20 has strong inter-rater reliability and significant predictive validity in postrelease community violence, and moderate-to-large effect sizes.2 This study used the HCR-20 to assess discharged psychiatric patients in Hong Kong.