Risk Assessment

Literature on Risk Assessment (Still under construction with links to material on the old webpage)

The following is a listing of periodicals, articles, studies, etc. (arranged in reverse chronological order), and a few websites, dealing with the clinical assessment of future dangerousness.  Copies of most are available (by email request) to defense counsel ONLY.  When requesting a document, please identify yourself and your affiliation.  Please let us know of any material you come across that would be helpful to others. THANK YOU.

Websites

RISK ASSESSMENT TOOLS

LITERATURE ON RISK ASSESSMENT

Elbogen, E, & Johnson, S. “The Intricate Link Between Violence and Mental Disorder.” American Journal of Psychiatry, 2009;66(2):152-161

Bivariate analyses showed that the incidence of violence was higher for people with severe mental illness, but only significantly so for those with co-occurring substance abuse and/or dependence. Multivariate analyses revealed that severe mental illness alone did not predict future violence; it was associated instead with historical (past violence, juvenile detention, physical abuse, parental arrest record), clinical (substance abuse, perceived threats), dispositional (age, sex, income), and contextual (recent divorce, unemployment, victimization) factors. Most of these factors were endorsed more often by subjects with severe mental illness.

Monahan, J. “Recent Advances in Violence Risk Assessment.” Stanford Center for Law & the Bioscience, November 29, 2008

Although the general public maintains a strong belief in the relation between violence and mental disorder, a majority of patients with mental illnesses are not violent (Swanson, 1991) though patients with histories of substance abuse are more likely to commit violent acts (MacArthur Violence Risk Assessment Study, Steadman, 1998).

Hart, S., Michie, C., & Cooke, D. “Precision of Actuarial Risk Assessment Instruments.” British Journal of Psychiatry, 190 (suppl. 49) (2007)

The ARAIs [actuarial risk assessment instruments] cannot be used to estimate an individual’s risk for future violence with any reasonable degree of certainty and should be used with great caution or not at all.

Lidz, C.. Grisso., T, et al. “Violence and People with Mental Illness Served in the Public Mental Health System.” Center for Mental Health Services Research, University of Massachusetts Medical School, September 2004, Vol 1, Issue 7.

[A]mong people with mental illness who do not have co-occurring substance abuse problems, the frequency of violence is only modestly higher than that of people who are not mentally ill and live in similar neighborhoods. Thus, mental illness by itself may not be a significant predictor of violence.

Hare, R.D., Gretton, H., Catchpole, R.  “Psychopathy and Offending From Adolescence to Adulthood: A 10-Year Follow-Up.”  Journal of Consulting and Clinical Psychology. Vol. 72, No. 4, 636–645 (2004)

The risk for violence into early adulthood was greater among those with high PCL:YV [Psychopathy Checklist: Youth Version] scores than among those with low scores, even after controlling for conduct disorder, age at first offence, and history of violent and nonviolent offending. These results indicate that the PCL:YV provides meaningful information about young offenders’ risk for violence into early adulthood.

Douglas, K. & Ogloff, J.  “Multiple Facets of Risk for Violence: The Impact of Judgmental Specificity on Structured Decisions About Violence Risk.” International Journal of Forensic Mental Health, Vol. 2, No. 1, pp. 19-34 (2003).

Bjørkly, S. &  Havik, O.  “TCO Symptoms as Markers of Violence in a Sample of Severely Violent Psychiatric Inpatients.”  International Journal of Forensic Mental Health, Vol. 2, No. 1, pp. 87-97 (2003).

Hall, H. & Ebert, R. Violence Prediction: Guidelines for the Forensic Practitioner, 2nd Ed.Charles C. Thomas Publishers (2002).

Litwack, T.R. “Some Questions for the Field of Violence Risk Assessment and Forensic Mental Health: Or, “Back to Basics” Revisited.” 1 International Journal of Forensic Mental Health (No. 2) 171-178 (2002).

How to best evaluate and compare clinical and actuarial assessments of dangerousness.

Rice, M.E., Harris, G.T., Quinsey, V.L. “The Appraisal of Violence Risk.” 15 Current Opinions in Psychiatry (No. 6) 589-593 (2002)

Dynamic predictors may contribute little to the question of who is at greatest risk, but may be valuable in predicting when an individual at high risk is likely to offend.

Loza, W., Villeneuve, D.B., Loza-Famous, A. “Predictive Validity of the Violence Risk Appraisal Guide: A Tool of Assessing Violent Offender’s Recidivism.”  25 International Journal of Law and Psychiatry 85-92 (2002)

The VRAG did not significantly predict violent behavior during community release. When the base rate of behavior in a population to be evaluated is known or strongly suspected to be different from that of the development sample for a given instrument, use of the instrument may not be defensible.

Smith, Paula, et al.  “The Effects of Prison Sentences and Intermediate Sanctions on Recidivism: General Effects and Individual Differences.”  Solicitor General of Canada. (2002)

Berlin, F.S., Galbreath, N.W., Geary, B., McGlone, G., “The Use of Actuarials at Civil Commitment Hearings to Predict the Likelihood of Future Sexual Violence,” in press, (2002)

It is questionable whether mental health professionals can make accurate predictions of future behavior; in general, mental health professionals are better at managing (i.e., reducing) risk, rather than trying to predict it. Actuarial measures can potentially be very misleading if one incorrectly attributes the overall risk of a previously screened group to a specific individual within it.

Hart, S.D.  “Actuarial Risk Assessment: Commentary on Berlin et al.”  in press (2002)

How, if at all, to use and interpret actuarial instruments for recidivism risk prediction. What the numbers mean.

Webster, Christopher, et al. “Violence Risk Assessment: Using Structured Clinical Guides Professionally.”  International Journal of Forensic Mental Health, Vol. 1, No. 2 (2002).

Belfrage, H. & Douglas, K.  “Treatment Effects on Forensic Psychiatric Patients Measured With the HCR-20 Violence Risk Assessment Scheme.”  International Journal of Forensic Mental Health, Vol. 1, No. 1, pp. 25-36 (2002).

Sjöstedt, G. & Grann, M.  “Risk Assessment: What is Being Predicted by Actuarial Prediction Instruments?”  International Journal of Forensic Mental Health, Vol. 1, No. 2, pp. 179-183 (2002).

Webster, C.D., Hucker, S.J., Bloom, H. “Transcending the Actuarial Versus Clinical Polemic in Assessing Risk for Violence.” 29 Criminal Justice and Behavior (No. 5) 659-665 (2002)

Both clinical and actuarial projections are important when assessing issues of future violence.

Skeem, Jennifer, et al.  “Identifying Psychiatric Patients at Risk for Repeated Involvement in Violence: The Next Step Toward Intensive Community Treatment Programs.” International Journal of Forensic Mental Health, Vol. 1, No. 2, pp. 155-170 (2002).

Litwack, Thomas. “Actuarial versus Clinical Assessments of Dangerousness.” Psychology, Public Policy, and Law, 2001, Vol. 7, No. 2, 409–443.  John Jay College of Criminal Justice and City University of New York

“although clinicians who engage in risk assessments certainly should be knowledgeable about arguably relevant actuarial assessment schemes and other assessment guides …, it is premature, at best, to replace clinical risk assessments with actuarial assessments.”

Hart, S.D. “Complexity, Uncertainty, and the Reconceptualization of Violence Risk Assessment.”  Closing address to the annual meeting of the European Association of Psychology and Law in Lisbon, Portugal, June 8, 2001,

Actuarial risk assessment tests that purport to offer quantitative predictions of the probability of future violence (“absolute risk tests”) are scientifically implausible and are not useful for assessment for risk of future violence.

Freedman, D. “False Prediction of Future Dangerousness: Error Rates and Psychopathy Checklist – Revised.”  29 Journal of the American Academy of Psychiatry and Law 89-95 (2001)

The high rate of false positive indications on the PCL-R suggest that is should not be used as a predictor of future violence in forensic settings where life and liberty are at stake.

MacArthur Violence Risk Assessment Study (2001).  [See also “Violence by People Discharged From Acute Psychiatric Facilities,” below.]

Monahan, John, et al.  “Developing a Clinically Useful Actuarial Tool for Assessing Violence Risk.”  British Journal of Psychiatry (2000).

Steadman, Henry, et al.  “A Classification Tree Approach to the Development of Actuarial Violence Risk Assessment Tools.”  Law and Human Behavior, Vol. 24, No. 1, 2000.

Sreenivasan, S., Kirkish, P., Garrick, T., Weinberger, L., Phenix, A. “Actuarial Risk Assessment Models: A Review of Critical Issues Related to Violence and Sex Offender Recidivism Assessments.” 28 Journal of the American Academy of Psychiatry and Law 438-448 (2000)

Risk appraisal should be based on guided clinical judgment by forensically trained clinicians. Utilization of a single model based on norm groups in tantamount to predicting that every individual is best described by a mean.

Rogers, R. “The Uncritical Acceptance of Risk Assessment in Forensic Practice.” 24 Law and Human Behavior (No. 5) 595-605 (2000)

Protective factors (circumstances mediating and moderating potentially maladaptive outcome) must be considered when assessing risk; base rate estimates may produce incorrect results when applied to non-specific populations.

Rogers, Richard. “The Uncritical Acceptance of Risk Assessment in Forensic Practice.”  Law and Human Behavior, Vol. 24, No. 5, 2000.

“Psychologists are offered a preliminary list of relevant issues for evaluating the merits of risk assessment in their forensic practices.”

Borum, Randy. “Advances in Assessments of Dangerousness and Risk.”  Psychological Expertise & Criminal Justice, 1999.

Good overview of history of risk assessment; description of current assessment instruments and guidelines for  practice.

Silver, E., Mulvey, E.P., Monahan, J. “Assessing Violence Risk Among Discharged Psychiatric Patients: Toward an Ecological Approach.” 23 Law and Human Behavior (No. 2) 237-255 (1999)

The characteristics of neighborhood environments into which psychiatric patients are discharged may be as important as the psychiatric condition of the patient at time of discharge in assessing and managing violence risk.

Data from the MacArthur Violence Risk Assessment Study indicate that where alcohol and substance abuse are not involved the incidence of violence among recently discharged “mental patients” is essentially the same as that of others living in the same neighborhoods! “Violence by People Discharged From Acute Psychiatric Facilities.” Archives of General Psychiatry, 55, 393-401 (May 1998). [Summary of findings]

VRAG (Violence Risk Appraisal Guide):  Quinsey, V.L., Harris, G.T., Rice, M.E., Cormier, C. “Violent Offenders, Appraising and Managing Risk. “American Psychological Ass’n, Washington, D.C. (1998).

HCR – 20 (Historical, Clinical & Risk Management Factors):  Webster, W.D., Douglas, K.S., Eaves, D., Hart, S.D. “HCR-20, Assessing Risk for Violence.” Mental Health, Law and Policy Institute, Simon Frazier University (1997)

A guide for assessment for risk of future violence. Not a formal psychological test (p. 1), rather an “aide-mémoire” and “research instrument” (p. 5). Intended as a “checklist of risk factors for violent behaviour” [sic] (p. 10). Broad definition of “violence” (p. 24). Not specifically directed to sexual behavior.

Cohen, D. “Notes on the Clinical Assessment of Dangerousness in Offender Populations.”  Psychiatry On-Line (1997).

Borum, Randy, et al.  “Assessing and Managing Violence Risk in Clinical Practice.” Journal of Practical Psychiatry and Behavioral Health, Vol. 2, No. 4, 1996.

Review of techniques for assessing violence risk and the accuracy of predictions of violence.  “[M]ental health professionals do have some ability to predict future violence (at least at a level that exceeds chance), but [clinicians] continue to make a considerable number of incorrect predictions (particularly false positives) …”

Monahan, J., Steadman, H.J. “Violent Storms and Violent People, How Meteorology Can Inform Risk Communication in Mental Health Law.” 51 American Psychologist (No. 9) 931-938 (1996)

Risk assessment in mental health law and in meteorology both attempt to predict rare and severe events. Treating violence predication as analogous to weather prediction has a number of heuristic implications for mental health law.

Mossman, D. “Assessing Predictions of Violence: Being Accurate About Accuracy.” 62 Journal of Consulting and Clinical Psychology (No. 4) 783-792 (1994)

ROC analysis offers tentative assessments of accuracy of violence prediction by mental health professionals, using statistical mentions that avoid the pitfalls of previously used descriptors of accuracy. However the data evaluated do not allow mental health professional to claim any special ability to discriminate violent patients from those who will not be violent.

Mossman, D., Hart, K.J. “How Bad is Civil Commitment? A Study of Attitudes Toward Violence and Involuntary Hospitalization.” 21 Bulletin of the American Academy of Psychiatry and Law (No. 2) 181-194 (1993)

Decision theory can be used to analyze attitudes about false-negative and false-positive decisions concerning involuntary hospitalization to establish optimum thresholds for initiating involuntary hospitalization. Such decisions are now typically made using informal, preconscious, and often error-prone heuristics and weightings of outcomes that reflect the opinions, concerns, and fears of court or medical personnel.

Heilbrun, K. “The Role of Psychological Testing in Forensic Assessment.” 16 Law and Human Behavior (No. 3) 257-272 (1992)

“Despite the apparent widespread use of psychological tests in evaluations performed by psychologists to assist legal decision makers, there has been little critical but balanced examination of the appropriate parameters for the forensic use of such tests. The following discussion examines the nature of legal decision making, and concludes that the primary legal criterion for the admissibility of psychological testing is relevance to the immediate legal issue or to some underlying psychological construct. Assuming that accuracy is a more consistent concern for psychologists performing such evaluations, the criticisms of various commentators are discussed. Some criticisms appear appropriate and are incorporated into a set of proposed guidelines for the use of psychological tests in forensic contexts. Other criticisms appear misplaced, however, and the call for a wholesale ban on psychological testing in the forensic context is rejected.”

Cocozza, J.J., Steadman, H.J., “Prediction in Psychiatry: An Example of Misplaced Confidence in Experts.” 25 Social Problems (No. 3) 265-276 (1978)

Although prediction is usually considered to be an integral part of science, judicial confidence in prediction of future dangerousness of patients by psychiatrists is not justified empirically. A major gap exists between the real criteria in psychiatric decision making and the ideal criteria offered by psychiatrists in explaining their decisions.

Cocozza, J.J., Steadman, H.J., “The Failure of Psychiatric Predictions of Dangerousness: Clear and Convincing Evidence.” 29 Rutgers Law Review 1084-1101 (1976)

Psychiatric prediction of dangerousness of mental patients were not at all accurate based on a variety of measures. Patients evaluated as dangerous were no more dangerous than those evaluated as nondangerous.

PCL-R-2d – Robert D. Hare, Ph.D.

DeMatteo, D and Edens, J. “The Role and Relevance of the Psychopathy Checklist–Revised in Court:A Case Law Survey of U.S. Courts (1991–2004).” Psychology, Public Policy, and Law, Vol. 12, No. 2, 214–241 (2006)

“The Psychopathy Checklist–Revised (PCL–R; R. D. Hare, 1991, 2003) is the most empirically validated instrument for measuring psychopathy in correctional and forensic psychiatric populations. The PCL–R’s predictive utility with criminal justice populations has led to its frequent use by clinicians conducting forensic assessments in criminal and sexually violent predator (SVP) cases. Despite its apparent wide acceptance in U.S. courts, little is known about how often the PCL–R is being introduced, the types of cases in which it is being used, and whether claims made in court regarding psychopathy are empirically defensible and/or relevant to the question at hand. This project documents some uses of the PCL–R in U.S. courts from 1991 through 2004 by year, jurisdiction, type of evaluation, and party. The results suggest that the PCL–R is being used by expert witnesses with increasing regularity across U.S. jurisdictions, primarily to assess risk of future violence. A review of 3 recent cases is also provided that illustrates concerns about the validity of the PCL–R for certain types of legal questions that may arise in criminal and SVP trials.”

Gendreau, P., Goggin, C., Smith, P. “Is the PCL-R Really the “Unparalleled” Measure of Offender Risk?”  29 Criminal Justice and Behavior (No. 4) 397- 426 (2002)

Review of studies of the effectiveness of the PCL-R as a risk assessment measure. Suggests that psychopathy may be more useful as a measure of responsivity in case management than for potential recidivism.

Websites

MacArthur Research Network on Mental Health and the Law

Violence Risk.com. A website devoted to research on the “Assessment & Management of Violence Risk.”

Website of Robert Hare, Ph.D. (Developer of Psychopathy Checklist: “PCL”).

Website of Stephan Hart, Ph.D. (Co-Developer of Psychopathy Checklist – Revised: “PCL-R”)

International Journal of Forensic Mental Health