Assessing the risk of violent and fear-inducing behaviour in the mentally disordered

Assessing the risks of violence in mentally disordered individuals is, as with suicide risk, an uncertain process that tends to produce high numbers of false positives, as well as the occasional failure to recognise imminent danger. Ideally we should have a data base on which actuarial estimates could be made, but in our present state of knowledge careful clinical assessment and common sense have to suffice. When the result of assessing a patient as at risk of being violent is to increase the level of support and therapeutic activity provided few ethical issues arise. When involuntary hospitalisation or curtailment of rights follows, the assessment of dangerousness must be soundly based and persuasive. The assessment of dangerousness remains a dubious business but on occasion it is our business.