Confidence and accuracy in assessments of short-term risks presented by forensic psychiatric patients

Forensic mental health professionals are asked to estimate with appropriate confidence the likelihood of adverse outcomes. But what is an 'appropriate' level of confidence? We examined this question in the context of short-term assessments of risk for violence, suicide, self-harm, and unauthorized leave. Using the Short-Term Assessment of Risk and Treatability (START), treatment team members (n = 23) completed 331 assessments of 137 forensic psychiatric patients appearing before the British Columbia Review Board over a six-month period. Assessors additionally indicated confidence in the accuracy of their risk assessments. Clinical-legal outcome data were collected prospectively for one year using a modified version of the Overt Aggression Scale (OAS). Overall, assessors were highly confident in the accuracy of their assessments; however, analyses revealed few differences in accuracy as a function of confidence. When significant differences were observed, higher confidence was associated with lower predictive accuracy. Findings suggest that assessors may benefit from feedback regarding predictive validity of past assessments and speak to the importance of comprehensive and ongoing training in risk assessment.