Risk

Risk is a combination of two key concepts: -

(a) the chance or possibility of harm - the probability;

(b) the nature and extent of the harm or injury - the loss.

[ Large and Nielssen ; the Psychiatrist, November 2011.



"The essence of risk management lies in maximising the areas where we have some control over the outcome while minimising the areas where we have absolutely no control over the outcome and the linkage between effect and cause is hidden from us."

Bernstein P, Against the Gods: The Remarkable Story of Risk. 1996



The risk management approach when undertaken properly includes participation from a number of stakeholders including the patient, family, and health professionals in efforts to reduce or mitigate risk factors that are drawn from larger population studies, from information available in the clinical encounter and from collateral sources.

Assessing risk is a task inherent in psychiatric assessment, and its' importance lies less in the assignation of a category of risk (high, low) than in the way the risks identified inform a treatment or management plan.
The plan will ideally include the set of indicated interventions, delivered within an expected time frame, that are considered best to manage and reduce the risks."

letter to the psychiatrist
O'Connor Clinical Director Scott Clinic



Role of risk assessment in reducing homicides by people with mental illness. Munro and RumgayBritish Journal of Psychiatry, 176, 116120.

Predictability of homicide

Eleven inquiries (27.5%) concluded that the violence could have been predicted
and 29 (72.5%) considered that there had been insufficient evidence to alert professionals

Twenty-four (60%) of the patients had a history of violence or high-risk factors for violence
but in only eight did the inquiries consider that there was evidence for judging them to be high risk at the time of the homicide.
Sixteen patients who had long-term indicators of violence did
not show any imminent signs to indicate that their state of mind was changing significantly. .....

..... Mental health services have a dual commitment to maximise the welfare of patients and to protect the public from harm.
The policy of community care has, for most patients, led to improved quality of life
although the level of funding has meant that they have not received an optimum level of care and treatment.
Treatment in the community rather than in isolated institutions has, however, made people with mental disorders more visible to the general public.

Their behaviour can, at times, appear strange and frightening.
They can actually be violent, usually to themselves but very occasionally to others.
Their victims are usually relatives or professionals known to them, with only 13% being strangers (Taylor & Gunn, 1999)

. As the public inquiries show, there are serious obstacles to increasing public safety
by improving risk assessment and targeting services on those deemed potentially violent.
Mental health professionals have limited ability to predict rare incidents of violence.

However, they have considerable skill in diagnosing and treating mental illness. The public would be better protected by having a good standard of care for all patients.

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