Determining Security Level in Forensic Psychiatry: a Tug of War Between the DUNDRUM Toolkit and the HoNOS-Secure

Criteria to determine in which level of security forensic patients should receive treatment are currently non-existent in Belgium. Research regarding the assessment of security level is minimal, and limited instruments are available. This study investigated the instruments that measure the need for security level: DUNDRUM-1 and the HoNOS-Secure. The psychometric properties of the DUNDRUM-1, DUNDRUM-2 and the HoNOS-Secure were investigated. A random selection was made of 100 male forensic patients in prison. The DUNDRUM-1, DUNDRUM-2 and the HoNOS-Secure were scored retrospectively. A subsample of the files was rated by four researchers (n = 38). Comparisons were made with the security level as decided by the court. The DUNDRUM-1 achieved excellent inter-rater reliability, and the HoNOS-Secure and DUNDRUM-2 got a moderate score. The internal consistency was highest for DUNDRUM-1 followed by the HoNOS-Secure and was low for the DUNDRUM-2. Both the DUNDRUM-1 and the HoNOS-Secure predicted allocations by the court to high security. The DUNDRUM-1 outperforms the HoNOS-Secure on psychometric properties and provides clear instructions with regard to the assessment of the security level. Training seems to be important for scoring the DUNDRUM-1. The current study provided more evidence for the applicability of the DUNDRUM-1 in Belgian settings with regard to determining the need for security.