BJPsych Bulletin: Volume 44 -

The HCR-20 and violence risk assessment – will a peak of inflated expectations turn to a trough of disillusionment?
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- BJPsych Bulletin Against the stream Collection
Edward Silva
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03 April 2020, pp. 269-271
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Summary
The HCR-20 has taken on a life of its own. In forensic services it has been elevated from helpful aide-mémoire into a prophetic tool worthy of Nostradamus himself. Almost every outcome is interpreted through it. Despite the evidence of its limited utility, the difficulties of predicting rare events, the narrative fallacies and other heuristic biases it creates, and the massive opportunity costs it entails, commissioners and services alike mandate its use. Yet in routine practice the problems are not acknowledged, multiple conflicts of interest lie unobserved and other opportunities are neglected.

Child psychiatry: a model for specific goals for in-patient treatment linked to resources and limitations in out-patient treatment
Simon R. Wilkinson
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24 April 2020, pp. 272-274
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Summary
I present a rationale for two different types of in-patient child psychiatric unit: 24/7 intensive units and 24/5 child and family units. Intensive units address safety requirements. The developing personality of young people is at the centre of in-patient approaches on the child and family units. This requires attachment-informed practice. Families must always be involved and placement of units must facilitate their participation. The primary skill characterising these units is use of the milieu for therapy and combining this with family therapy. In other words, nurses and allied professionals need to be the dominant force in unit development, under the reflective guidance of consultants and clinical psychologists.

A model for specific goals for in-patient treatment linked to resources and limitations in out-patient treatment
Virginia Davies
Published online by Cambridge University Press:

24 April 2020, pp. 275-276
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Summary
The author reflects on the Norwegian inpatient service descriptions contained in Wilkinson's article, considering the challenges laid out in his piece from the perspective of a child and adolescent psychiatrist working in a hospital crisis setting, as well as within the context of child and adolescent mental healthcare staffing across the UK.

BJPsych Bulletin