Risk Assessment in Psychiatric Practice
Hashman, Kenneth, Canadian Journal of Psychiatry
Every day, clinicians assess risk in various settings. Psychiatrists in all forms of practice are asked to use their skills to forecast the risk of violence: Is the patient dangerous? Should the patient be detained against his or her will? When can we safely release the patient into the community? These are just a few of the formidable questions that are asked daily in clinical practice.
Given these expectations, how are we to navigate the inherent uncertainties of risk assessment? Providing didactic education and clinical training for residents within the core psychiatric curriculum would seem essential. Continuing professional development is equally important for psychiatrists to remain well informed of developments in the field. This issue's In Review section highlights many developments, both in Canada and internationally, along with their clinical implications.
The first article, by Dr Hy Bloom and colleagues, gives us a historical overview and suggests implications for current psychiatric practice from a Canadian perspective (1). Canadians have contributed significantly to the international literature on risk assessment, and Bloom and colleagues highlight the importance of assessing the risk of violence to others. They describe this as "undoubtedly the most essential and onerous risk decision-making area (civil commitment) for psychiatrists," and offer psychiatrists contemporary risk assessment principles to guide clinical practice.
The second article, by Dr Graham Glancy and Dr Gary Chaimowitz, provides an overview of the clinical use of risk assessment (2). These authors argue that risk assessment should be part of daily clinical psychiatric practice-indeed, not only risk assessment but, more importantly, risk management and risk reduction. Glancy and Chaimowitz advocate for the use of as much information as possible, including clinical (dynamic), historical (static), and collateral information. This in turn allows clinicians to consider the imminence and severity of potential violence, under what circumstances this risk will be increased, and what can be changed to reduce the risk. In this regard, the authors point out that, in practice, risk assessment becomes an exercise in risk management.
The third article, by Dr Michael Norko and Dr Madelon Baranoski, gives an international perspective on the state of contemporary risk assessment research (3). …