Practical aspects of clinical risk assessment and management

Abstract

It is debatable whether the notion of dangerousness now has any utilitarian value for psychiatry. The presence or absence of dangerousness is very much in the eye of the beholder. It is an all or nothing term – you either have it or you do not! While there is usually little disagreement about the few very violent individuals “who, for 24 hours a day, and in any situation, are likely to cause harm to others” (Chiswick, 1995), most patients are not in this category and “little bit dangerous” is unlikely to be of much comfort to clinical staff. It is unhelpful to deny that dangerousness is any more than an adjective which has been elevated into a pseudoscientific construct whose definitions (Scott, 1977; Walker, 1978; Home Office & DHSS, 1975) amount to little more than “past harm predicts future behaviour”.