Predictive validity of the HCR-20 for violent and non-violent sexual behaviour in a secure mental health service

Laura E. O'Shea, Dev-Kishan Thaker, Marco M. Picchioni, Fiona L. Mason, Caroline Knight, Geoffrey L. Dickens

Research output: Contribution to journalArticle

2 Citations (Scopus)
125 Downloads (Pure)

Abstract

Background
Violent and non-violent sexual behaviour is a fairly common problem among secure mental health service patients, but specialist sexual violence risk assessment is time-consuming and so performed infrequently.

Aims
We aimed to establish whether a commonly used violence risk assessment tool, the Health Clinical Risk management 20(HCR-20), has predictive validity specifically for inappropriate sexual behaviour.

Methods
A pseudo-prospective cohort design was used for a study in the adult wards of a large provider of specialist secure mental health services. Routine clinical team HCR-20 assessments were extracted from records, and incidents involving inappropriate sexual behaviour were recorded for the 3 months following assessment.

Results
Of 613 patients, 104 (17%) had engaged in at least one inappropriate sexual behaviour; in 65 (10.6%), the sexual act was violent. HCR-20 total score, clinical and risk management subscales, predicted violent and non-violent sexual behaviour. The negative predictive value of the HCR-20 for inappropriate sexual behaviour was over 90%.

Conclusions
Prediction of violent sexual behaviour may be regarded as well within the scope of the HCR-20 as a structured professional judgement tool to aid violence risk prediction, but we found that it also predicts behaviours that may be of concern but fall below the violence threshold. High negative predictive values suggest that HCR-20 scores may have some utility for screening out patients who do not require more specialist assessment for inappropriate sexual behaviour.
Original languageEnglish
Pages (from-to)366-379
Number of pages14
JournalCriminal Behaviour and Mental Health
Volume26
Issue number5
Early online date21 Jun 2015
DOIs
Publication statusPublished - Dec 2016

Fingerprint

Risk Management
Mental Health Services
Sexual Behavior
Health
Violence
Sex Offenses

Cite this

O'Shea, Laura E. ; Thaker, Dev-Kishan ; Picchioni, Marco M. ; Mason, Fiona L. ; Knight, Caroline ; Dickens, Geoffrey L. / Predictive validity of the HCR-20 for violent and non-violent sexual behaviour in a secure mental health service. In: Criminal Behaviour and Mental Health. 2016 ; Vol. 26, No. 5. pp. 366-379.
@article{2e52cd3510034378b08af43bf722b66f,
title = "Predictive validity of the HCR-20 for violent and non-violent sexual behaviour in a secure mental health service",
abstract = "BackgroundViolent and non-violent sexual behaviour is a fairly common problem among secure mental health service patients, but specialist sexual violence risk assessment is time-consuming and so performed infrequently.AimsWe aimed to establish whether a commonly used violence risk assessment tool, the Health Clinical Risk management 20(HCR-20), has predictive validity specifically for inappropriate sexual behaviour.MethodsA pseudo-prospective cohort design was used for a study in the adult wards of a large provider of specialist secure mental health services. Routine clinical team HCR-20 assessments were extracted from records, and incidents involving inappropriate sexual behaviour were recorded for the 3 months following assessment.ResultsOf 613 patients, 104 (17{\%}) had engaged in at least one inappropriate sexual behaviour; in 65 (10.6{\%}), the sexual act was violent. HCR-20 total score, clinical and risk management subscales, predicted violent and non-violent sexual behaviour. The negative predictive value of the HCR-20 for inappropriate sexual behaviour was over 90{\%}.ConclusionsPrediction of violent sexual behaviour may be regarded as well within the scope of the HCR-20 as a structured professional judgement tool to aid violence risk prediction, but we found that it also predicts behaviours that may be of concern but fall below the violence threshold. High negative predictive values suggest that HCR-20 scores may have some utility for screening out patients who do not require more specialist assessment for inappropriate sexual behaviour.",
author = "O'Shea, {Laura E.} and Dev-Kishan Thaker and Picchioni, {Marco M.} and Mason, {Fiona L.} and Caroline Knight and Dickens, {Geoffrey L.}",
year = "2016",
month = "12",
doi = "10.1002/cbm.1967",
language = "English",
volume = "26",
pages = "366--379",
journal = "Criminal Behaviour and Mental Health",
issn = "0957-9664",
publisher = "John Wiley and Sons Ltd",
number = "5",

}

Predictive validity of the HCR-20 for violent and non-violent sexual behaviour in a secure mental health service. / O'Shea, Laura E.; Thaker, Dev-Kishan; Picchioni, Marco M.; Mason, Fiona L.; Knight, Caroline; Dickens, Geoffrey L.

In: Criminal Behaviour and Mental Health, Vol. 26, No. 5, 12.2016, p. 366-379.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predictive validity of the HCR-20 for violent and non-violent sexual behaviour in a secure mental health service

AU - O'Shea, Laura E.

AU - Thaker, Dev-Kishan

AU - Picchioni, Marco M.

AU - Mason, Fiona L.

AU - Knight, Caroline

AU - Dickens, Geoffrey L.

PY - 2016/12

Y1 - 2016/12

N2 - BackgroundViolent and non-violent sexual behaviour is a fairly common problem among secure mental health service patients, but specialist sexual violence risk assessment is time-consuming and so performed infrequently.AimsWe aimed to establish whether a commonly used violence risk assessment tool, the Health Clinical Risk management 20(HCR-20), has predictive validity specifically for inappropriate sexual behaviour.MethodsA pseudo-prospective cohort design was used for a study in the adult wards of a large provider of specialist secure mental health services. Routine clinical team HCR-20 assessments were extracted from records, and incidents involving inappropriate sexual behaviour were recorded for the 3 months following assessment.ResultsOf 613 patients, 104 (17%) had engaged in at least one inappropriate sexual behaviour; in 65 (10.6%), the sexual act was violent. HCR-20 total score, clinical and risk management subscales, predicted violent and non-violent sexual behaviour. The negative predictive value of the HCR-20 for inappropriate sexual behaviour was over 90%.ConclusionsPrediction of violent sexual behaviour may be regarded as well within the scope of the HCR-20 as a structured professional judgement tool to aid violence risk prediction, but we found that it also predicts behaviours that may be of concern but fall below the violence threshold. High negative predictive values suggest that HCR-20 scores may have some utility for screening out patients who do not require more specialist assessment for inappropriate sexual behaviour.

AB - BackgroundViolent and non-violent sexual behaviour is a fairly common problem among secure mental health service patients, but specialist sexual violence risk assessment is time-consuming and so performed infrequently.AimsWe aimed to establish whether a commonly used violence risk assessment tool, the Health Clinical Risk management 20(HCR-20), has predictive validity specifically for inappropriate sexual behaviour.MethodsA pseudo-prospective cohort design was used for a study in the adult wards of a large provider of specialist secure mental health services. Routine clinical team HCR-20 assessments were extracted from records, and incidents involving inappropriate sexual behaviour were recorded for the 3 months following assessment.ResultsOf 613 patients, 104 (17%) had engaged in at least one inappropriate sexual behaviour; in 65 (10.6%), the sexual act was violent. HCR-20 total score, clinical and risk management subscales, predicted violent and non-violent sexual behaviour. The negative predictive value of the HCR-20 for inappropriate sexual behaviour was over 90%.ConclusionsPrediction of violent sexual behaviour may be regarded as well within the scope of the HCR-20 as a structured professional judgement tool to aid violence risk prediction, but we found that it also predicts behaviours that may be of concern but fall below the violence threshold. High negative predictive values suggest that HCR-20 scores may have some utility for screening out patients who do not require more specialist assessment for inappropriate sexual behaviour.

U2 - 10.1002/cbm.1967

DO - 10.1002/cbm.1967

M3 - Article

VL - 26

SP - 366

EP - 379

JO - Criminal Behaviour and Mental Health

JF - Criminal Behaviour and Mental Health

SN - 0957-9664

IS - 5

ER -