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An audit of the quality of HCR-20 violence risk assessments in a low secure service

Published online by Cambridge University Press:  09 December 2015

Piyal Sen*
Consultant Forensic Psychiatrist, St Andrew’s Essex and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neurosciences, London, UK
Simone Lindsey
Assistant Psychologist, St Andrew’s Essex, UK
Nilanjan Chatterjee
Consultant Psychiatrist in Learning Disability, Weston Super Mare, previously Higher Trainee in Learning Disability, East of England Deanery, UK
Rajesh Rama-Iyer
Senior Speciality Doctor, St Andrew’s Essex, UK
Marco Picchioni
Senior Lecturer, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neurosciences, and Consultant Forensic Psychiatrist, St Andrew’s Northampton, UK
Correspondence to: Dr Piyal Sen, St Andrew’s Essex, Pound Lane, Benfleet, Essex SS12 9JP. E-mail:;
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The HCR-20 is one of the most popular structured clinical judgement tools used in forensic settings; yet, there are no published tools to assess the quality of its use. This study used the CAI-V, a tool to assess the competency of those carrying out risk assessment, to develop a quality tool for the use of HCR-20.


The audit was carried out between July 2012 and July 2013 on all patients resident in St Andrew’s Essex, a low secure unit. The results of the first audit led to an action plan for clinical improvement, subsequently re-audited a year later.


Most of the HCR-20 ratings scored in the competent range in both audits, but the greatest weakness was identified in the treatment planning section. The re-audit showed improvement, but there remained areas for development.


The audit highlighted broad areas of improvement like the need for full multidisciplinary involvement, more attention to formulation, and the need for greater consultation and information gathering from outside professionals and family members. The quality tool developed could be adapted to the requirements of any service, and used accordingly.

Original Research Article
Copyright © NAPICU 2015 

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