Differences between clinicians and researchers in assessing risk of violence in forensic psychiatric patients

Abstract

Do clinicians and researchers differ in their violence risk assessment of the same patient? In this study, the Dutch version of the HCR-20 was coded by two independent researchers and two independent clinicians (treatment supervisor and group leader) for 60 patients admitted to a Dutch forensic psychiatric hospital. The aim of the study was threefold: (1) to establish the interrater reliability of the Dutch HCR-20; (2) to gain insight into differences between researchers and clinicians in coding the HCR-20; and (3) to examine the relationship between clinicians' feelings towards their patients and their risk judgment. Overall, the interrater reliability of the HCR-20 was good. The group leaders gave significantly lower HCR-20 scores than the researchers. There were no significant differences between the mean HCR-20 scores of treatment supervisors and researchers, but there was a significant difference in the interpretation of the scores: treatment supervisors had more ‘low risk’ judgments than researchers. Furthermore, it was found that feelings of clinicians towards their patients were associated with their risk judgment. Feelings of being controlled and manipulated by the patient were related to higher HCR-20 scores, whereas positive feelings (helpful, happy, relaxed) were related to lower risk judgments.

Keywords:

• risk assessment
• violence
• HCR-20
• interrater reliability
• countertransference feelings

ACKNOWLEDGEMENTS

The authors wish to thank all clinicians and researchers who participated in this study. Special thanks go to Cécile Vandeputte-van de Vijver who functioned as workshop trainer together with the first author and also participated as a researcher in the study.

Notes

Eighteen of the 60 patients were sex offenders. We consider this group too small and will not present results on the interrater reliability of the SVR-20 at this moment.

There are capacity problems in the Dutch tbs-system, resulting in a strong call on the forensic psychiatric institutions to complete the treatment of patients within a specific time period.