The clinical use of risk assessment.

Department of Psychiatry, University of Toronto, Ontario.
Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.41). 02/2005; 50(1):12-7.
Source: PubMed

ABSTRACT 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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    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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