What should the next generation of risk assessment look like?

After 4 decades of research in mental health risk assessment, where are we headed ?

The next generation approach requires some bigger-picture humanistic thinking, not more and more technology. Assessment and management of the risk of violence in psychiatry inevitably and appropriately draws on emotionally laden ‘intuitive’ modes of thought, as well as deliberative analytic thinking.

A quick google search of ‘fifth generation risk assessment’ throws up a variety of possible avenues. Some suggest refining assessments with evidence from neurobiological research…. Some suggest ‘exemplar based modelling’…There seems to be a rush for ever-more sophisticated technologies to be brought to bear.

We would argue that the next generation approach requires instead some bigger-picture humanistic thinking—not more and more technology. Ten years on from Douglas Mossman’s classic paper (Mossman 2006) arguing that risk assessment and management in mental health cannot be divorced from personal and social values, we remain stuck in a paradigm that often ignores the key role of values.

The 5th generation can fruitfully draw on service-user driven models, such as ‘Collaborative Person-Centred Safety Planning (Boardman and Roberts 2014).
We need to continue to make use of our research-derived tools and approaches but in such a way that:

  • Explicitly recognizes that ‘management interventions’ are inherently value-laden
  • Acknowledges the value of ‘intersubjectivity’ in understanding future risk and that :
  • o top-down ‘objectification’ of the client/patient/service user is a therapeutic dead-end;
  • o we need to foster mutual responsibility in a ‘grown-up’ discourse of equals
  • Considers the inevitability that risk interventions carry ‘silent harms’ and hence grapples with contentious issues such as when coercive approaches may be needed or not.

The future is in our hands…

Journal paper by Andrew Carroll

References
1. Boardman, J. and Roberts, G. (2014) “Risk, Safety and Recovery”
2. Mossman, D. (2006). “Critique of Pure Risk Assessment or, Kant Meets Tarasoff.” University of Cincinnati Law Review 75: 523-609

For more on Recovery-oriented approaches to risk in mental health, including access to a training course for Mental Health Practitioners, click here to proceed to the website and course.

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