Practicalities of HCR-20 implementation within secure psychiatric services

The HCR-20 is established as the de-facto tool for the assessment of violence risk within forensic psychiatric services. Although much has been written about the value of the tool, less has been written about the practicalities of achieving meaningful completion of HCR-20 assessments at a service level. The present paper seeks to review recommendations within the literature and also those based upon the authors’ own experiences in HCR-20 implementation, reviewing a number of the common issues and barriers encountered within the development of a strategic, service-level, approach to completion of the HCR-20. Possible solutions to these problems are also considered. We conclude that although there is not necessarily a single approach that is right for every service, certain principles need to be followed to ensure high quality assessments. Further, we develop a number of ‘good practice points’ which will be useful for services considering this issue on a strategic level, as well as commissioners evaluating the quality of HCR-20 completion within services.