Psychiatric patient violence: assessment and management of risk

Abstract

The relationship between violent behaviour and mental illness is both complex and contentious. In recent years, public attention has focused on what may be considered tragic failures of care in the community. Partly in response to subsequent enquiries, new government guidance and legislation have emerged which seek to reinforce the role of the mental health practitioner in assessing and managing the risk of psychiatric patient violence. This paper describes the development of a risk assessment framework in relation to psychiatric patient violence. The framework focuses on the evaluation of past behaviour as a key element of risk assessment, and offers guidance on appropriate areas of enquiry. The central aim of assessment is to identify in what circumstances the risk of violence may be increased, and to plan care accordingly. This approach reflects an emphasis on the situational factors that may surround violent behaviour and in doing so, moves away from viewing risk assessment as a one-off decision that can somehow distinguish the safe from the dangerous.