At Risk of What? Understanding Forensic Psychiatric Inpatient Aggression through a Violence Risk Scenario Planning Lens

Abstract Violence risk assessment is an essential component of forensic mental health services designed to help mitigate and manage the re-occurrence of violence. Although there is large body of evidence supporting structured risk assessments, there is no empirical evidence regarding scenario planning—a specific component of the structured professional judgment approach to violence risk assessment. The purpose of this study was to investigate the base rates and concurrent validity of inpatient aggression scenarios to provide information about risk scenarios. Among a large representative sample of forensic psychiatric patients (N = 1240), the prevalence of risk scenarios (Repeat, Escalation, Twist, and Improvement scenarios) was investigated by retrospectively coding changes in inpatient aggression. The results suggested that Improvement scenarios, including a continued desistance of aggression, were common. Aggression scenarios shared significant pattern of associations with the Historical-Clinical-Risk Management-20 and the Psychopathy Checklist—Revised. Overall, this study presents initial empirical evidence related to violence risk scenario planning. Implications from these findings include how scenario planning may intersect with evaluator bias in forensic mental health assessments.