Shared Risk Formulation in Forensic Psychiatry.

Patients in forensic mental health care have a difficult journey through inpatient rehabilitation and re-integration into the community. Risk assessment guides this progress, usually with clinician-based processes that use structured risk-assessment tools. Patients' understanding of their own risk is important to inform risk assessment and the chances of successful rehabilitation. The emergence of shared decision-making approaches provides an opportunity to consider shared risk assessment and formulation. We reviewed the literature to explore models of patients' involvement in risk assessment and the impact on outcomes in forensic mental health care. We conducted searches of three databases (Medline, PsychINFO, and EMBASE) to identify papers that employed shared risk understanding for violence risk. Additional records were identified through review of citations, with articles being selected using a predetermined set of inclusion and exclusion criteria. We found five studies that met the inclusion criteria for patient involvement in risk assessment with measurement of construct or predictive validity. The studies employed diverse methodologies, but they suggest that patient involvement in assessing risk is feasible when correlated with staff ratings. There is encouraging evidence of the predictive validity of self-rated risk alongside staff-rated risk assessment.