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The assessment and management of the risk of a person with a
mental illness causing harm to another is an extremely important
part of psychiatric practice. It is integral to providing safe and
effective care and making decisions on transition between services.
This guide to good practice is produced for psychiatrists, but
might also be useful to other healthcare professionals, patients
and carers, as all have a part to play in risk management.
A full background to this Good Practice Guide is given in the
body of CR201 (Royal College of Psychiatrists, 2016).
Risk cannot be eliminated, but it can be rigorously assessed and
managed or mitigated.
A history of violence or risk to others is vitally
A risk assessment should identify key factors that indicate a
pattern or that risk is increasing.
Risk is dynamic and can be affected by circumstances that can
change over the briefest of time-frames. Therefore, risk assessment
needs to include a short-term perspective and frequent review.
Some risks are specific, with identified potential victims.
Risk of violence increases in the teen years, with a peak from
late teens to early 20s, then a dramatic reduction in the late 20s
and a slow reduction until the 60s, when there is another marked
Empirical research cannot be relied upon to identify all risk
Specialist risk assessment may be required (e.g. sex
Clear communication of the outcome of risk assessment and the
management plan is essential.
A formulation and plan should specifically describe the current
situation and say what could be done to mitigate the risk in
Patient-identifying information may be shared:
with the patient’s explicit consent; or
on a need-to-know basis when the recipient needs the information
because they will be involved with the patient’s care (where staff
from more than one agency are involved, the patient needs to be
told that some sharing of information is likely); or
if the need to protect the public outweighs the duty of
confidentiality to the patient.
Patients who present a risk to others may also be vulnerable to
other forms of risk (e.g. self-harm, self-neglect, retaliation or
exploitation by others).
A positive risk-taking approach weighs up the benefits of
interventions and autonomy.
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