Risk Assessment in Mental Health Care: Values and Costs

TY - JOUR

T1 - Risk Assessment in Mental Health Care: Values and Costs

AU - Rose, Nikolas

AU - Szmukler, George

N1 - This is article is not freely accessible but may have access through institution

PY - 2013

Y1 - 2013

N2 - Risk assessment has assumed increasing salience in mental health care in a number of countries. The frequency of serious violent incidents perpetrated by people with a mental illness is an insufficient explanation. Understandings of mental illness and of the role of those charged with their care (or control) play a key role. ‘Moral outrage’, associated with an implied culpability when certain types of tragedy occur, is very significant. This leads to tensions concerning the role of post-incident inquiries, and contributes to a flawed conception of what such inquiries can offer. At the same time, understandings of probability and prediction are generally very poor, among professionals as well as the public. Unrealistic expectations for risk assessment and management in general psychiatric practice carry a variety of significant costs, taking a number forms, to those with a mental illness, to mental health professionals and to services. Especially important are changes in professional practice and accountabilities that are significantly divorced from traditional practice, implications for trust in patient-clinician relationships and the organisations in which mental health professionals work, and practices that often breach the ethical principle of justice (or fairness) and heighten discrimination against people with mental illness.

AB - Risk assessment has assumed increasing salience in mental health care in a number of countries. The frequency of serious violent incidents perpetrated by people with a mental illness is an insufficient explanation. Understandings of mental illness and of the role of those charged with their care (or control) play a key role. ‘Moral outrage’, associated with an implied culpability when certain types of tragedy occur, is very significant. This leads to tensions concerning the role of post-incident inquiries, and contributes to a flawed conception of what such inquiries can offer. At the same time, understandings of probability and prediction are generally very poor, among professionals as well as the public. Unrealistic expectations for risk assessment and management in general psychiatric practice carry a variety of significant costs, taking a number forms, to those with a mental illness, to mental health professionals and to services. Especially important are changes in professional practice and accountabilities that are significantly divorced from traditional practice, implications for trust in patient-clinician relationships and the organisations in which mental health professionals work, and practices that often breach the ethical principle of justice (or fairness) and heighten discrimination against people with mental illness.

U2 - 10.1002/bsl.2046

DO - 10.1002/bsl.2046

M3 - Article

SN - 0735-3936

JO - Behavioral Sciences and the Law

JF - Behavioral Sciences and the Law

ER -