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An understanding of the concept of risk assessment is by no means exclusive to the forensic mental health field.1 However, decisions made as a product of such risk assessments in the context of mental health have fundamental ethical implications for the public, policy makers, and practitioners. There is a danger of losing sufficient sight of such issues with a literature which appears more characterised by the discussion and construction of the latest “structured risk assessment tools”. The field is replete with the presentation and promotion of such “tools” to potentially receptive policy makers and practitioners. The underlying assumption, and perhaps appeal, of such approaches to risk assessment is that if only we sharpen our tools further we will be able to accurately predict and prevent harm. In an environment of media and public concern about risk assessment and practices in the forensic mental health field, such Faustian seeds may seem to be sown with impunity.
LIMITATIONS TO RISK ASSESSMENTS
As a starting point to this editorial it is worth reflecting on the fundamental question of what we mean by risk assessment. The term risk is used in a variety of sometimes conflicting ways in forensic practice. It is used as a synonym for the concept of “dangerousness”. It is referred to as both a cause and effect. Historically notions of risk have also been conflated with the potentially overlapping area of “prediction”. A major concern here is when statements of probability are mistaken for predictions about the actual behaviour of an individual. Logically such a “prediction” suggests a specific level of probability of a behaviour occurring, rather than of the behaviour itself as a predicted outcome. It follows that the test of such “predictions” lies in group outcomes, for a significant number of cases. So, for example, a clinician may make an assessment …
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