The State of Contemporary Risk Assessment Research

By Norko, Michael A.; Baranoski, Madelon V. | Canadian Journal of Psychiatry, January 2005 | Go to article overview

The State of Contemporary Risk Assessment Research

Norko, Michael A., Baranoski, Madelon V., Canadian Journal of Psychiatry

The focus on assessing dangerousness in routine psychiatric practice developed when relatively little was known about factors related to violence, and the accuracy of predicting violence was distinctly below chance. Since the 1990s, however, significant research attention has been directed toward factors related to violence and mental illness, as well as toward factors related to the accuracy of risk assessment techniques. Sociodemographic and environmental variables have been identified as significant predictors of violence, as has the presence of substance abuse. However, the data on specific mental health variables are somewhat mixed. Many studies point to a modest increased risk of violence associated with major mental illness and psychosis, whereas other noteworthy studies have failed to confirm such findings. Studies of the accuracy of risk assessments indicate that both actuarial and clinical methodologies perform better than chance, although the former achieve greater statistical accuracy. Despite ongoing controversies, risk management strategies that encompass the strengths and limitations of our present knowledge are available to clinicians.

(Can J Psychiatry 2005;50:18-26)

Information on author affiliations appears at the end of the article.

Key Words: clinical risk assessment, actuarial risk assessment, research, correlates of violence, prediction of violence

In 1990 President George HW Bush proclaimed the next 10 years as the "decade of the brain" (1). The proclamation's purpose was "to enhance public awareness of the benefits to be derived from brain research" (1).The year 1990 also marks the beginning of the contemporary era of research on mental illness and violence. However, despite significant advances in knowledge about risk assessment and the correlates of violence, a 1996 study of public opinion demonstrated increasing public consciousness of an association between mental illness and "dangerous[ness] to self or others" (2).

The paradigm of dangerousness evolved in the 1960s and 1970s from the confluence of at least 3 sociopolitical movements related to psychiatry and from the legal cases that highlighted them (3). The first of these was the deinstitutionalization movement, which, in creating an alternative option to hospital care, emphasized the need for criteria to decide between inpatient and outpatient care. The second movement was the increased use of voluntary hospitalization for psychiatric patients. In 1971 most psychiatric patients in the US were for the first time hospitalized voluntarily (4). With the advent of the popular use of voluntary hospitalization came the demand for involuntary hospitalization criteria that could withstand the increased scrutiny levelled at involuntary commitments. The third variable was the civil rights movement, which spawned an increase in libertarian advocacy for persons with mental illness; the highest possible standards were sought for the involuntary deprivation of liberty occasioned by civil commitment. Various civil commitment cases confirmed repudiation of the parens patriae standard and reliance on government police powers and the dangerousness standard (according to which dangerousness to self or others becomes the principal determinant of eligibility for involunatry commitment) (5-8).

Despite widespread adoption of the dangerousness standard in commitment proceedings and extension ofthat standard to psychiatric outpatients (9-11), capital defendants (12,13), and insanity acquittees (14), no data supported the idea that psychiatrists or other mental health professionals could reliably determine future dangerousness. In fact, Monahan's 1981 review of the literature demonstrated that mental health professionals were wrong in 2 out of 3 attempts to predict dangerousness (15).

Prominent forensic mental health professionals (16-19) and the American Psychiatric Association (20) attempted to critique this new paradigm and modify its evolution in mental health care. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Cite this article

Cited article

Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25,

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

The State of Contemporary Risk Assessment Research


Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25,

    New feature

    It is estimated that 1 in 10 people have dyslexia, and in an effort to make Questia easier to use for those people, we have added a new choice of font to the Reader. That font is called OpenDyslexic, and has been designed to help with some of the symptoms of dyslexia. For more information on this font, please visit

    To use OpenDyslexic, choose it from the Typeface list in Font settings.

    OK, got it!

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search


    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.