Chief complaint: Homicidal. Assessing violence risk
A structured approach can help identify risk factors, including those not due to mental illness.
Although certain mental illnesses increase the relative risk of violence (compared with people without mental illness),5,6 recent studies suggest that mental illness plays only a “minor role in explaining violence in populations.”7 It is estimated that as little as 4% of the violence in the United States can be attributed to mental illness.1 According to a 1998 meta-analysis of 48 studies of criminal recidivism, the risk factors for violent recidivism were “almost identical” among offenders who had a mental disorder and those who did not.8
Approaches to assessing violence risk
Psychiatrists can assess the risk of future violence via 3 broad approaches.9,10
Unaided clinical judgment is when a mental health professional estimates violence risk based on his or her own experience and intuition, with knowledge of violence risk factors, but without the use of structured tools.
Actuarial tools are statistical models that use formulae to show relationships between data (risk factors) and outcomes (violence).10,11
Continue to: Structured professional judgment
