The assessment of risk

Abstract

When we consider issues of risk and dangerousness it is natural to think of settings where people who have demonstrated acts of violence are kept, such as special hospitals, secure units, prisons, etc. Indeed, there is often some kudos attached to those who work directly with people at the extreme end of the violence/risk spectrum. By working on a daily basis with offenders and/or patients who have acted out their aggressive tendencies, staff develop skills in managing such people in an institutional setting. Most importantly they work as a team, backed up by elaborate security systems and techniques for minimizing and controlling violent behaviour. Moreover, as staff spend many hours each day with those in their care, they quickly become familiar with an individual’s changes of mood and demeanour. Staff are often aware, for example, of the possibility of difficulties from a patient on a particular day, by his demeanour on waking. The opportunities for such intimate contact enable staff to gauge the propensity for violent behaviour fairly accurately although there is always the possibility of the unexpected ‘flare-up’. Even in these instances the staff team is able to fall back on well-rehearsed routines of intervention and containment.