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The Royal College of Psychiatrists Improving the lives of people with mental illness

CR201. Rethinking risk to others in mental health services

Price: £0.00

Approved: 2016

Published: Aug 2016

Status: current

Number of pages: 47

Review by: 2021

Download free PDF version

This report is only available online – there are no printed copies available to buy. Please use the link above to view and download a PDF file of the main report.

Assessment and management of risk to others (Good Practice Guide):

In 2008, the Royal College of Psychiatrists published Rethinking Risk to Others in Mental Health Services (CR150). This was the first of several reports addressing issues of risk, with risk to others prioritised in the context of high-profile incidents implicating risk-management issues in mental health services.

There is no conflict between patient and public interest. The College has established the Patient Safety Working Group, comprising a broad range of psychiatrists from different specialities with additional input from patient and carer representatives, to revise CR150 in the context of a considerably altered commissioning environment. Poor management of risk, quite rightly, raises public concern but also has the potential for life-changing and devastating consequences for those concerned.

Public concern about risk has not changed. However, the significance of risk as a public issue is subjective as well as objective. The public perception of risk includes not only the probable frequency and magnitude of a future event but also the culture in which the perception of risk operates. In public debate, some psychiatrists have argued that the emphasis on risk in psychiatric patients is inappropriate or excessive. Meanwhile, statutory bodies see a role for mental health services to address public safety by better risk management in the general population.

Over the past 10 years, the number of homicides by mental health patients has remained stable, with a slight decline in recent years. This is against a background of an increase in the overall homicide rate in the UK. Risk management remains a core role of psychiatrists, but is also a multidisciplinary, and indeed political, matter.

Tensions remain, and psychiatrists’ duty to protect the public needs to be integrated with their primary duty to assess and treat their patients. Thus ‘risk to others’ gets to the heart of our profession, and our ability to assess and manage risk is a key part of our professional identity.

This report lays out principles of best practice to be adopted. We advocate referring to the Good Practice Guide, provided in the Appendix (and above to download). As with all approaches to risk formulation, this acts as an aide memoire to good practice, but does not replace the need for full clinical assessment in which risk assessment is one component.

This replaces CR150, of the same title.


Patient Safety Expert Guidance Working Group

Executive summary

Key findings and recommendations


Part I. Introduction

  • Background
  • Risk assessment in mental health services
  • The commissioning environment

Part 2. Assessing the risk posed to others

  • Approaches to risk assessment
  • Structured risk-assessment tools
  • Assessing and managing risk: responsibilities

Part 3. Training and information sharing

  • Training and continuing professional development
  • Communication and information sharing
  • Appendix. Assessment and management of risk to others: good practice guide (download from the link at the top of this page)
  • References and further reading
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