Risk assessment as collective clinical judgement.
BACKGROUND
Risk assessment occupies an increasingly important position in psychiatry. This paper contends that collective judgement is the optimal method of assessing risk.
Risk has a dual meaning: emotional and judgemental.
Assaults, threats and survival anxiety.
Staff wariness and resistance, attribution of blame.
For a group to function well it must have a clear task. Custodial roles can lead to ambiguity.
Externally directed hostility, internal homogenization of views.
Rituals can develop in forensic institutions, as well as militarism. ANTI-THERAPEUTIC CULTURE: Sadism may develop where a marked power differential develops.
Danger intensifies the feelings about leaders, perhaps idealization, perhaps disaffection. Leaders and others need to agree on risk assessment or fragmentation will occur.
The assessment of risk may modify it. Mutual hostility must be reduced. Dialogue and understanding are needed.
The environment should be less authoritarian and more democratic, so that patients can join a group and internalize its values. Reflective space is also required.


CONCLUSIONS
Risk assessment is best described in terms of human endeavour, not in the language of scientific measurement.
Murphy
Denis
D
South London and Maudsley NHS Trust, Department of Forensic Psychiatry, London, UK. Drdjmurphy@aol.com
D000328:Adult; D000987:Antisocial Personality Disorder / Q000453:epidemiology / Q000523:psychology*; D003617:Dangerous Behavior; D004739:England; D005239:Fear; D005555:Forensic Psychiatry; D006801:Humans; D007389:Internal-External Control; D010348:Patient Care Team; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D018570:Risk Assessment / Q000706:statistics & numerical data*; D012927:Social Control, Informal; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data