Risk assessment and management

Abstract

The violent patient Introduction Many view risk assessment as being firmly within the realm of forensic mental health practitioners. In everyday practice, however, all mental health practitioners knowingly or unknowingly pay attention to those factors that give rise to concern, either in the patient's history or at presentation. Indeed, the Care Programme Approach (Department of Health 1992) requires the assessment of need including risk. The area of risk assessment has been one of increasing interest in the light of numerous Government initiatives such as the supervision register (Department of Health and Home Office 1994), supervised discharge (Secretary of State for Health 1997), Clinical Governance, the National Service Framework for Mental Health (Secretary of State for Health 1997), the Home Office paper ‘Managing Dangerous People With Severe Personality Disorder’ (Kapur 2000). Proposals for Policy Development (July 1999; Department of Health 1999c) and the proposed Mental Health Bill which has since been abandoned in its current form. Mention of a formal risk assessment often arouses anxieties in staff carrying out the assessment. ‘Risk assessment is surrounded by an aura of mystique, which it does not deserve. The basis for risk management is a thorough clinical assessment, which any multidisciplinary team should be able to undertake’ (Maden 2003). This chapter focuses on those issues relevant to everyday practice encountered by Psychiatric Intensive Care Unit (PICU) multidisciplinary teams. De-institutionalisation has led to a larger number of potentially high-risk patients living in the community, some not in receipt of adequately resourced care.