Risk Assessment: Patient and Detainee

Abstract

Risk assessment is required in a variety of legal and clinical settings. Nevertheless, there is still substantial disagreement about its scientific validity and how best to implement it into practice, which has led to extensive empirical research into its tenability. Violence risk factors can be grouped into four categories: (i) dispositional, reflecting personal traits and tendencies to act in a particular way; (ii) historical, indexing events in the past that may predispose a person to become violent; (iii) contextual, referring to elements in the current environment that are conducive to violence; and (iv) clinical, including features of mental illness, level of functioning, and substance abuse. Over the years the primary goal of risk assessment has shifted from simple determination of who would become violent in the future, to risk management, which allows for reduction of violence. There are two primary approaches to risk assessment: unstructured, based solely on clinical experience and professional opinion, and structured, which requires professionals to follow specific rules of identification and definition of risk factors. Structured risk assessment in turn includes two approaches: (i) actuarial, which relies on an algorithm to combine risk factors, which enter the final decision regarding future violence; and (ii) structured professional judgments (SPJs), which allow the decision maker to consider how nomothetically supported risk factors are relevant to a given individual, and what management strategies would mitigate risk. Commentary and research addressing the strengths and weaknesses of these approaches is provided.