No abstract

Risk assessment differs from other medical interventions in that the welfare of the patient is not the immediate object of the intervention. However, improving the risk assessment process may reduce the chance of risk assessment itself being unjust. We explore the ethical arguments in relation to risk assessment as a medical intervention, drawing analogies, where applicable, with ethical arguments raised by general medical investigations. The article concludes by supporting the structured professional judgement approach as a method of risk assessment that is most consistent with the respect for principles of medical ethics. Recommendations are made for the future direction of risk assessment indicated by ethical theory.

SummaryThere is an inexorable drive in psychiatric services in the UK, including forensic services, towards organising and delivering care based on the principles of the recovery model. Hence recovery, and its subjective and objective measures, is the goal of these services and the standard by which the quality of the service is evaluated. At the same time, all psychiatric services are expected to practise evidence-based risk assessment and management practices and can be subject to severe criticism or sanctions if they do not do so. In this paper I set out the view that the values that underlie the recovery approach and the clinical risk assessment approach appear to be polar opposites. However, an understanding of human behaviour using a humanneeds model is an explanatory paradigm that underlies both the recovery model and the understanding of risk behaviour, and can thus unify these two approaches. Therefore a more explicit integration of this model into forensic care would be beneficial and there should be more research directed to the correlates of recovery-oriented measures and risk-related measures.

Previous research has indicated that autism is over-represented among inpatients in forensic high secure hospitals in England. The aim of this study was to assess the feasibility of estimating the prevalence of autism without an intellectual disability in medium secure units (MSU). Male inpatients on three MSU wards were approached to participate in the study following ethical approval. Patients who met the inclusion criteria and consented were screened for autism using the AQ (Autism Quotient), and the EQ (Empathy Quotient). Out of a total of 46 patients on these wards, sixteen individuals were ineligible to participate. Of the remaining 30, 12 (40%) subsequently consented to participate. After ruling out an intellectual disability using the Schonell Graded Work Reading Test, these individuals were screened for autism using the AQ, and completed the EQ. None of those who participated scored above screening threshold for further diagnostic testing using the AQ. However, three inpatients (of the original 46 patients on these wards) were previously diagnosed with Asperger's Syndrome suggesting a prevalence of 6.5% (95% CI 1.7-.18.9 %). The results indicate that this group is over-represented within medium secure forensic psychiatric units and highlight the difficulties in undertaking research in this population.