When psychiatrists are liable: risk management and violent patients

In an era of rapid discharge and community treatment, psychiatrists must assess, with insufficient information, their patients' potential for committing a violent act outside of the hospital every time they authorize a pass or a discharge. The authors review court decisions on prediction of dangerousness and research data on the risk of homicide, assault, and suicide among released mental patients. They then discuss a risk-management approach to decision-making that consists of three components--risk assessment, risk evaluation, and risk reduction. The authors also provide a decision table that clinicians can use to identify factors that suggest a high risk of violence in a patient's current status, history, and treatment response.