The development of the Medium Security Recidivism Assessment Guide (MSRAG): an actuarial risk prediction instrument

Abstract

The majority of patients in medium secure services in the UK have a primary diagnosis of major psychosis. Currently available actuarial risk prediction instruments have limited application, having been developed in different jurisdictions on samples with different characteristics. The Medium Security Recidivism Assessment Guide (MSRAG) was developed to assess risk of acquisitive and serious offending in patients with schizophrenia and delusional disorder. It assesses static predictor variables and is designed for use at the pre-discharge stage of rehabilitation. Results indicate the MSRAG has good predictive accuracy, and acquisitive and serious offending scales were cross-validated. Dynamic risk factors occurring post-discharge interact with four levels of ascribed risk, impacting especially on those at high risk. The MSRAG can be easily scored from case file information, does not require extensive training, and can be used to screen patients routinely prior to discharge. Observed interactions with dynamic factors after discharge can guide clinical risk management.

Keywords:

• actuarial risk
• dynamic risk
• mentally ill
• recidivism
• acquisitive
• serious offending

Acknowledgements

This study was funded by a grant from the Wellcome Trust. It would not have been possible without the cooperation of clinical and administrative staff in the NHS medium secure units of North-West Thames, North-East Thames, West Midlands, Merseyside, North West region, South West region, and East Anglia, as well as those in the private hospitals Kneesworth House, Stockton Hall, and St. Andrew's Hospital.