Psychopathy and standardized risk assessment

Abstract

Throughout history most societies have assumed a link between mental disorder and violence to others. In recent times there has been increasing concern in the UK over law and order, specifically the risk of violence, and these issues are now high on the political and mental health agendas. In mental health services, clinical decisions on risk are made at all stages of the patient care process. For mental health professionals violence risk assessment and management are key components of clinical practice. In response there is a need to adopt a clear structured approach to violence risk assessment and management that is evidence-based. Psychopathy, as described by Robert Hare and colleagues, has received much attention from both clinicians and researchers in recent times, mainly due to impressive research findings from North America and Europe that demonstrate the significant predictive validity of the Psychopathy Checklist scales. The research findings are briefly discussed and a method of comparing predictive accuracy of risk-assessment tools, using receiver operating characteristics, is illustrated. The advantages of clinical and actuarial approaches to risk assessment are briefly reviewed and a structured professional judgement approach is discussed that combines these approaches. Actuarial prediction tools and recently developed schemes from Canada and North America that promote structured professional judgement are described, and practical implementation considerations are suggested.