Assessing and managing the risks of violence towards others 

Assessing and managing the risk of our patients being violent towards others now occupies a prominent position in virtually all forms of mental health practice, but it remains a contentious area. At the highest level researchers, psychometricians, and statisticians argue about almost every aspect, even whether anything useful can be said about individual outcomes rather than group indicators. At the next level an industry flourishes of selling training, and risk assessment tinstruments, to those who then appear as experts in a wide range of mental health and criminal justice contexts. On the ground, almost everyone in mental health is drawn into filling out purpose-designed forms and complying with protocols, most of little or no demonstrated validity. This chapter is intended to make clinicians aware of both the possibilities and limitations of existing approaches to the assessments of risk. Given that there is no reason for mental health professionals to evaluate risk without gaining information to manage it, this chapter will also address the management of risk for aggression and violence.