Violence risk assessment is essential to the operation of forensic psychiatric hospitals. These environments face unique challenges, as they frequently house high-risk violent offenders alongside mentally ill and vulnerable populations. Consequently, forensic hospitals require both effective violence-reduction interventions and accurate risk assessment practices to ensure the safety of staff, patients, and the public. Historically, these assessments relied on unstructured clinical judgment, which has been criticized for being subjective and yielding inaccurate predictions. Modern forensic practice has shifted toward the Structured Professional Judgment (SPJ) model, which provides an evidence-based framework for assessment and management.
Among the most validated and utilized SPJ tools in forensic settings are the Historical Clinical Risk Management-20, Version 3 (HCR-20-V3), the Short-Term Assessment of Risk & Treatability (START), and the Structured Assessment of Violence Risk in Youth (SAVRY). For psychologists conducting evaluations, understanding how to compare and apply these instruments is essential for developing high-quality opinions that inform treatment, discharge planning, and courtroom testimony.