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.
Download: 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
. 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
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
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
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
Key findings and recommendations
Part I. Introduction
- Risk assessment in mental health
- The commissioning environment
Part 2. Assessing the risk posed to
- Approaches to risk assessment
- Structured risk-assessment tools
- Assessing and managing risk:
Part 3. Training and information
- Training and continuing professional
- 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