Risk Assessment and Management

Abstract

Increased risk of harm to self and others occurs in sev­eral mental disorders, and the prediction and assess­ment of risk has become an important component of psychiatric practice. Fatal self- harm— or suicide— is the most important risk to assess. At least a brief assessment of suicidal risk should be included in all psychiatric assessments. However, harm to others— both homicide and non- fatal harm— is increased in some mental disorders, and a thorough assessment of the nature, severity, and likeli­hood of such risks will often form an important part of a psychiatric assessment. When assessing risk, it is useful to consider static and dynamic risk factors. Static risk factors cannot be changed, whereas dynamic risk fac­tors change over time and include mental disorder. Generally, the assessment of risk should include: … ● the nature of the risk; ● the probability of the risk in the short and longer term; ● whether there are any factors that increase the risk; ● whether there are any factors that decrease the risk; ● whether there are any interventions that may reduce the risk. … A risk management plan will aim to: … ● reduce the risk; ● review the risk. … Often, the most appropriate intervention to reduce risk will be to ensure that the patient is offered the most effective treatment for their specific condition. For example, a depressed person with suicidal idea­tion may be offered a low- toxicity antidepressant and regular follow- up. On the other hand, the management of a new mother with a postpartum psychotic depres­sive disorder who has thoughts of harming her new child may involve specific intervention to reduce the risk of harm to her baby as well as effective therapy for the depressive disorder. Many patients deliberately take drug overdoses or harm themselves in other ways. Some die (suicide, completed suicide); others survive (attempted suicide, parasuicide, or deliberate self- harm). The characteris­tics of those who kill themselves and those who harm themselves are rather different, although they overlap.