Assessing the risk of violence in patients

Risks can be assessed, but the results still pose ethical and political dilemmas

Papers p 1112

Is it possible to predict violence by patients in clinical practice? Politicians are all too ready to assume that it is and that healthcare professionals are at fault when a mentally ill person commits a violent act. Epidemiological approaches examining the inter-relationship between violence and mental illness have suggested that an association exists but that it is small.1^–3 Fifteen years ago research suggested that clinicians were more often wrong than right in their risk predictions4 but more recent studies have shown that clinicians are getting better at predicting risk of violence, albeit in the short term.5

An influential longitudinal cohort study of psychiatric inpatients from the United States showed that the one year prevalence rate of violence was 18% for those with major mental disorder and 31% for patients with comorbid substance misuse disorder.6 Actuarial and clinical research studies have identified risk factors associated with violence drawn from a variety of domains. Key risk factors include demographic factors (being male, young, and in the lowest socioeconomic class),1 a history of previous violence, …