Patient involvement with the HCR-20: a qualitative interview study of professionals’ experiences of collaborative risk assessment and management

Purpose The assessment and management of violence risk is integral to a patient’s care pathway in secure mental health care. Risk assessment tools, such as the Historical Clinical Risk-20 (HCR-20), are embedded in practice, framing an individual’s risk and supporting clinical decision-making across the care pathway. Patient involvement in their risk assessment is fundamental; however, achieving effective and impactful collaboration is complex and our understanding of the mechanisms and context in which collaboration works is limited. This study aimed to investigate the views and experiences of professionals regarding patient involvement with the HCR-20. Design/methodology/approach The authors interviewed 21 psychiatrists and psychologists working in secure mental health care. Data were analysed using the framework method. Findings The analysis identified that while patients were consistently interviewed, where feasible, to gather information to construct the HCR-20, more meaningful involvement and collaboration in the HCR-20 assessment and for the formulation of risk management were described as inconsistent and varied. The themes further describe participant views on facilitators and barriers to collaboration and the perceived benefits of involving patients in the HCR-20. Practical implications Further research and service evaluations are needed to review and evaluate real-world in-practice approaches to collaborative risk assessment. Clinical services should strive to reduce the perceived variation and inconsistency observed in this study, address barriers to collaboration and promote meaningful patient involvement. Originality/value This study addresses a significantly under-researched area, building an understanding of how patients are involved in their risk assessment, the extent to which collaboration is embedded in HCR-20 processes and the mechanisms and context in which collaboration occurs in real-world practice.