The clinical use of risk assessment

Department of Psychiatry, University of Toronto, Ontario.
Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.55). 02/2005; 50(1):12-7.
Source: PubMed


In this paper, we argue that risk assessment should be considered a part of daily clinical psychiatric practice. We discuss the advantages and disadvantages of various risk assessment procedures. In the event that a high risk for violence is present, we advise on strategies for discharging our duty to protect the public. Finally, by way of an illustrative case, we apply theory to practice and discuss the issues of risk management and risk reduction essential to a modern approach to psychiatry.

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    • "Numerous civil commitment cases confirmed the need to invoke the professional opinion of psychiatrists or other mental health professionals in the determination of ''dangerousness to self or others,'' which has become the principal determinant of eligibility for involuntary commitment (Norko & Baranoski, 2005). The increased utilization of voluntary hospitalization for psychiatric patients further heightened the need to clarify criteria for voluntary versus involuntary commitment (Brakel, Parry, & Weiner, 1985; Glancy & Chaimowitz, 2005). "
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    ABSTRACT: Within inpatient psychiatric settings exists evidence of a significant risk of violent incidents and incidents of deliberate self-harm. One of the most hidden and preventable mental health problems is the fact that approximately 1,500 suicides take place annually in inpatient hospital facilities throughout the United States. This article focuses on the advantages and disadvantages of risk and suicide assessment procedures while attempting to answer the following questions: What degree of risk currently exists on inpatient psychiatric facilities for harm to self and others? What can be done within the physical environment to protect the psychiatric patient? We discuss a combined risk and quality proactive approach to risk reduction through a safety equation integrating patient assessment, physical environment, program safety, and patient component to formalize a systems approach to the at-risk patient. © The Author 2005. Published by Oxford University Press. All rights reserved.
    Brief Treatment and Crisis Intervention 05/2005; 5(2):121-141. DOI:10.1093/brief-treatment/mhi014

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    ABSTRACT: very 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 educa- tion and clinical training for residents within the core psychi- atric curriculum would seem essential. Continuing professional development is equally important for psychia- trists to remain well informed of developments in the field. This issue's In Review section highlights many develop- ments, 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 psy- chiatric 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 psychia- trists," 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 manage- ment 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 sever- ity of potential violence, under what circumstances this risk will be increased, and what can be changed to reduce the risk.
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