Violence risk assessment and management in mental health: a conceptual, empirical and practice critique
| Date | 08 January 2018 |
| Pages | 3-13 |
| Published date | 08 January 2018 |
| DOI | https://doi.org/10.1108/JMHTEP-04-2017-0027 |
| Author | Patrick Callaghan,Andrew Grundy |
| Subject Matter | Health & social care,Mental health,Mental health education |
Violence risk assessment and
management in mental health:
a conceptual, empirical and practice critique
Patrick Callaghan and Andrew Grundy
Abstract
Purpose –The purpose of this paper is to examine empirical, epistemological and conceptual challenges
and clinical narratives in the application of risk assessment and management in mental health.
Design/methodology/approach –The authors used a narrative review of empirical, conceptual and
clinical literature.
Findings –The worldwide prevalence of violence in mental health settings remains high. Risk assessment
and management approaches, while well intentioned as an attempt to reduce harm and increase people’s
safety, have negligible effect on both. They are invariably individual centric, ignore wider environmental,
societal and behavioural influences that foment violence and have a stigmatising effect on people using
mental health services. They also reinforce the myth that people who are mentally unwell threaten society and
that through current risk assessment and management approaches, we can minimise this threat.
Research limitations/implications –There is a need to reconsider the study and application of violence
risk assessment in mental health.
Practical implications –The practice of risk assessment and management in mental health is marred by an
overuse of risk assessment measures that are limited in their predictive efficacy. As a result, they have little
value in preventing, reducing and/or managing harm. The language of risk punishes and stigmatises service
users and reinforces the image of menace. An alternative language of safety may nourish and protect.
A collaborative approach to safety assessment based upon recovery-focussed principles and practices may
fuse professionals and service users’horizons. Combining service users’self-perception, professionals’
sound clinical judgement, assisted by electronically derived risk algorithms and followed by evidence-based
risk management interventions, may lessen the threat to service users, reduce harm and transform the
practice of violence risk assessment and management.
Social implications –Risk appraisals discriminate against the small number of people who have a mental
illness and are risky, an example of preventive detention that is ethically questionable. On the basis of the
limitations of the predictive efficacy of actuarial measures, it is ethically dubious to subject people to
interventions with limited benefits. Risk assessment processes tend to reinforce stigma by classifying
individuals as risky, sanctioning society’s prejudices and fear through scientific authority.
Originality/value –The increasing focus on risk assessment and management to tackle violence in mental
health is fraught with empirical, conceptual and practical concerns; the authors have suggested ways in
which these concerns can be addressed without compromising people’s safety.
Keywords Violence, Challenges, Risk assessment
Paper type Conceptual paper
Introduction
Risk is the likelihood of behaviour that may be harmful or beneficial to oneself or to others. Risk
assessment involves analysing potential outcomes of this behaviour; risk management involves
devisinga plan to minimise harmfulbehaviour and maximisebeneficial behaviour(Callaghan, 2015).
Despite progressin the care and treatment of mentalhealth problems, the worldwide prevalenceof
violence directedat self or others remains high in mentalhealth settings. Subsequently,the last 20
years have seen increasing attention to risk assessment and management inmental health using
professional clinical judgement, the application of actuarial measures, or a combination of both.
Received 11 April 2017
Revised 14 September 2017
Accepted 5 October 2017
The authors acknowledge the
contributions of selected members
of the European Violence in
Psychiatry Research Group and
audience members for comments
on an earlier version of this paper
following a presentation at the 7th
Violence in Clinical Psychiatry
Congress in Prague in 2011.
Conflict of interest: the authors
declare no conflict of interest.
Patrick Callaghan is a
Professor of Mental Health
Science at the School of
Applied Sciences, London
South Bank University,
London, UK.
Andrew Grundy is based at the
School of Health Sciences,
University of Nottingham,
Nottingham, UK.
DOI 10.1108/JMHTEP-04-2017-0027 VOL. 13 NO. 1 2018, pp.3-13, © Emerald Publishing Limited, ISSN 1755-6228
j
THE JOURNAL OF MENTALHEALTH TRAINING, EDUCATION AND PRACTICE
j
PAGE 3
To continue reading
Request your trial