Forensic risk assessment in intellectual disabilities: The evidence base and current practice in one English region

The growing interest in forensic risk assessment in intellectual disability services reflects the perception that deinstitutionalization has exposed m ore people to a greater risk of offending. However, 'risk' and the related idea of 'dangerousness' are problematic concepts because of connotations of dichotomous definition, stability and predictability. Assessment instrumen ts in mainstream forensic psychiatry often combine actuarial and clinical d ata, and increasingly stress the dynamic nature of risk as well as the impo rtance of situational and accidental triggers. Despite this increasing soph istication of research in mainstream forensic psychiatry, the ability to pr edict future offending behaviour remains very limited. Furthermore, actuari al predictors developed in studies of psychiatric or prison populations may not be valid for individuals with intellectual disabilities. Offending beh aviour among people with intellectual disabilities is also hard to circumsc ribe because it often does not invoke full legal process or even reporting to the police. In order to discover how such problems were reflected in pra ctice, a survey of providers in the North-west Region of England was undert aken. Seventy out of 106 providers identified as possibly relevant to this inquiry responded to a short postal questionnaire. Twenty-nine (42%) respon dents - mainly in the statutory sector - reported operating a risk assessme nt policy relating to offending. The number of risk assessments completed i n the previous year varied from none to 'several hundred'. Providers report ed three main kinds of problems: (1) resources or service configuration; (2 ) interagency or interdisciplinary cooperation or coordination; and(3) issu es relating to the effectiveness, design and content of assessment.