Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-25T16:53:36.004Z Has data issue: false hasContentIssue false
  • English
  • Français

The assessment and management of risk in psychiatry: can we do better?

Published online by Cambridge University Press:  02 January 2018

Frank Holloway
Frank Holloway*
Affiliation:
Maudsley Hospital, Denmark Hill, London SE5 8AZ
Rights & Permissions [Opens in a new window]

Extract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

This is the final contribution to a five part series on risk in psychiatry. Bowden (1997) has cast a bleak eye on the realities of making risk decisions about difficult and dangerous patients, identifying the essential subjectivity of these decisions and the cognitive distortions that psychiatrists can undergo to make them apparently easier; distortions that can blind the clinician to impending disaster. Morgan (1997) emphasised the limitations of a simplistic ‘risk factor’ approach to the management of potentially suicidal patients, concluding that the priority is the refinement of our basic clinical skills (and by implication deployment of successful treatments for our patients' illnesses). Prins (1997) analysed the particular difficulties faced by mental health review tribunals hearing the cases of Restricted patients. The perhaps unsurprising conclusion is that tribunals make bad decisions when presented with inadequate information (which begs the question why not adjourn and seek the information required before proceeding?). Roy (1997) has addressed a range of risks faced by Trusts and the clinicians who work for them. There is a clear demand that Trusts develop risk management strategies: of necessity these strategies will discourage inherently risky behaviour such as inadequate staffing of in-patient units and the devolution of inappropriate levels of responsibility to staff who are inadequately trained or supported.

Type
Risk Assessment
Information
Psychiatric Bulletin , Volume 21 , Issue 5 , May 1997 , pp. 283 - 285
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © 1997 The Royal College of Psychiatrists

References

Alberg, C., Hatfield, B. & Huxley, P. (eds) (1996) Learning Materials on Mental Health Risk Assessment University of Manchester: School of Psychiatry and Behavioural Sciences.Google Scholar
Bowden, P. (1997) Risk management: from patient to client, Psychiatric Bulletin, 21, 36–38.Google Scholar
Chiswick, D. (1995) Dangerousness. In Seminars in Practical Forensic Psychiatry (eds Chiswick, D. and Cope, R.), pp. 210–242. London: Gaskell.Google Scholar
Eastman, N. (1996) Inquiry into homicides by psychiatric patients: systematic audit should replace mandatory review. British Medical Journal, 313, 1069–1071.CrossRefGoogle Scholar
Grounds, A. (1995) Risk assessment and management in clinical context. In Psychiatric Patient Violence – Risk and Response (ed. Crichton, J.), pp. 43–89. London: Duckworth.Google Scholar
Gunn, J. & Taylor, P. (1993) Forensic Psychiatry. Clinical, Legal and Ethical Issues. Oxford: Butterworth-Heinemann.Google Scholar
Left, J. (ed.) (1993) The TAPS project: Evaluating community placement of long-stay psychiatric patients. British Journal of Psychiatry, 162 (suppl. 19).Google Scholar
MacCarthy, A., Roy, D., Holloway, F., et al (1995) Supervision registers and the care programme approach: a practical solution. Psychiatric Bulletin, 19, 195–199.CrossRefGoogle Scholar
Morgan, G. (1997) Management of suicide risk. Psychiatric Bulletin, 21, 214–216.Google Scholar
Prins, H. (1996) Risk assessment and management in criminal justice and psychiatry. Journal of Forensic Psychiatry, 7, 42–62.Google Scholar
Prins, H. (1997) The Mental Health Review Tribunal and the restricted patient. Psychiatric Bulletin, 21, 102–104.Google Scholar
Roy, D. (1997) Clinical risk management: an emerging agenda for psychiatry. Psychiatric Bulletin, 21, 162–164.Google Scholar
Royal College of Psychiatrists (1996a) Assessment and Clinical Management of Risk of Harm to Other People. Council Report CR53. London: Royal College of Psychiatrists.Google Scholar
Royal College of Psychiatrists (1996b) Report of the Confidential Inquiry into Homicides and Suicides by Mentally Disordered Offenders. London: Royal College of Psychiatrists.Google Scholar
Taylor, P. J. (1995) Schizophrenia and the risk of violence. In Schizophrenia (eds Hirsh, S. R. & Weinberger, D. R.). pp. 163–183. Oxford: Blackwell Science.Google ScholarPubMed
Vinestock, M. (1996) Risk assessment. “A word to the wise”. Advances in Psychiatric Treatment, 2, 3–10.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.