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Rates of violence in persons identified as high risk by structured risk
assessment instruments (SRAIs) are uncertain and frequently unreported by
To analyse the variation in rates of violence in individuals identified
as high risk by SRAIs.
A systematic search of databases (1995–2011) was conducted for studies on
nine widely used assessment tools. Where violence rates in high-risk
groups were not published, these were requested from study authors. Rate
information was extracted, and binomial logistic regression was used to
Information was collected on 13 045 participants in 57 samples from 47
independent studies. Annualised rates of violence in individuals
classified as high risk varied both across and within instruments. Rates
were elevated when population rates of violence were higher, when a
structured professional judgement instrument was used and when there was
a lower proportion of men in a study.
After controlling for time at risk, the rate of violence in individuals
classified as high risk by SRAIs shows substantial variation. In the
absence of information on local base rates, assigning predetermined
probabilities to future violence risk on the basis of a structured risk
assessment is not supported by the current evidence base. This
underscores the need for caution when such risk estimates are used to
influence decisions related to individual liberty and public safety.
The written report is central to the practice of psychiatry in legal settings. It is required of mental health professionals acting as expert witnesses in criminal cases, civil litigation situations, child custody proceedings and risk assessments. This book provides a theoretical background to psychiatric writing for the law and a practical guide to the preparation of the report. The first section addresses practical and ethical concerns, including the conduct of the forensic psychiatric evaluation, conflicts of interest, record keeping and confidentiality. The second section contains practical and detailed advice on preparing various types of report, including reports for use in criminal and civil litigation, civil commitment hearings and child custody proceedings. A final section covers special issues arising during report preparation including the use of psychological tests and the detection of malingering. This is an essential guide for anyone required to write a psychiatric report.
The prominence of risk in UK social and criminal justice policy creates
opportunities, challenges and dangers for forensic psychiatry. The future
standing of the specialty will depend not only on the practical utility of
its responses to those opportunities and challenges, but also the ethical
integrity of those responses.