Understanding and managing risk

Assessing and managing risk to others from forensic patients is fundamental to the practice of mental health professionals in forensic services. Although the link between mental disorder and risk to others is nothing new (Monahan 1992), in recent times there has been increasing concern in the United Kingdom in relation to violent behaviour. Over the past two decades a relatively small yet significant number of incidents involving people with mental illness have received considerable media attention (e.g. Ritchie et al. 1994; NHS London 2006), and this has left a strong impression of the potential dangerousness to the public from individuals with various forms of mental disorder. A recent report (National Confidential Inquiry 2006), highlighted the fact that patients recently in contact with mental health services commit around 9 per cent of all homicides in England and Wales, which translates to 52 homicides per year and 30 by people diagnosed with schizophrenia. Findings like this fuel concern about perceived failures in provision of effective treatment and management and the overall competence of mental health services to prevent violent behaviour (Reed 1997). These perceived failures could be linked in the minds of the public with the perception of inadequate service provision, and with the growing concern that the public are not adequately protected from dangerous individuals by current legislation.