title: Predicting hospital aggression in secure psychiatric care.
abstract: BACKGROUND
  Risk assessment instruments have become a preferred means for predicting future aggression, claiming to predict long-term aggression risk.
  
  
  OBJECTIVE
  To investigate the predictive value over 12 months and 4 years of two commonly applied instruments (Historical, Clinical and Risk Management - 20 (HCR-20) and Violence Risk Appraisal Guide (VRAG)).
  
  
  METHODS
  Participants were adult male psychiatric patients detained in a high secure hospital. All had a diagnosis of personality disorder. The focus was on aggression in hospital.
  
  
  RESULTS
  The actuarial risk assessment (VRAG) was generally performing better than the structured risk assessment (HCR-20), although neither approach performed particularly well overall. Any value in their predictive potential appeared focused on the longer time period under study (4 years) and was specific to certain types of aggression.
  
  
  CONCLUSIONS
  The value of these instruments for assessing aggression in hospital among patients with personality disorder in a high secure psychiatric setting is considered.
  
  
  BACKGROUND
  J.L.I., C.A.M. and J.K. are employed by the trust where the data were collected.
  © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
authors.affiliation: , PhD, University of Central Lancashire, Preston, and Ashworth Research Centre, Mersey Care NHS Trust, Maghull, UK.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Ireland
authors.affiliation: , MSc, University of Bangor, Bangor and Ashworth Research Centre, Mersey Care NHS Trust, Maghull, UK.
authors.forename: Lee J
authors.initials: LJ
authors.lastname: Priday
authors.affiliation: , PhD, University of Central Lancashire, Preston, and Ashworth Research Centre, Mersey Care NHS Trust, Maghull, UK.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Ireland
authors.affiliation: , PhD, University of Central Lancashire, Preston, and Ashworth Research Centre, Mersey Care NHS Trust, Maghull, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Chu
authors.affiliation: , DClinPsychol, Ashworth High Secure Hospital, Mersey Care NHS Trust, Maghull, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kilcoyne
authors.affiliation: , MBChB, FRCPsych, Ashworth High Secure Hospital, Mersey Care NHS Trust, Maghull, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Mulligan