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Risk colonisation. Comments on assessment and risk management of violence in psychiatry
Author/s: Valentina Moretti, Gian Maria Galeazzi 
Year:  2015 Issue: Language: Italian 
Pages:  18 Pg. 71-88 FullText PDF:  2211 KB
DOI:  10.3280/RSF2015-003005
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Over the past decades, the issue of assessment and risk management of violence, in the field of mentally disordered offenders, has gained considerable importance. Professionals are increasingly invested with the task of assessing and managing the risk of violence. This development appears like a "risk colonisation". As a consequence, several structured risk assessment tools have appeared. These instruments should produce reliable and precise enough predictions, and help in taking complex decisions (i.e. using, or not, coercive measures). However, the authors express their general and ethical concern analysing the technical shortcomings - e.g. the insufficient positive predictive value - of these rating scales. They also highlight the current enthusiastic use of these measures in psychiatry and their impact on the patient-professional relationship. Finally, the authors suggest that the use of a therapeutic risk taking model is more appropriate, since it involves the collaboration with patients, other agencies and stakeholders, and draws on a range of human, professional, representative and advocacy skills. Thus, in the event of difficulties, this approach facilitates the co-construction of shared objectives in a sufficiently responsive and safe context.
Keywords: Violence risk assessment and management, violence, rating scales, mental health

  1. [1] Rothstein H, Huber M, Gaskell G. A theory of risk colonisation: the spiraling regulatory logics of societal and institutional risk. Economy and Society 2006; 35 (1): 91-112., DOI: 10.1080/0308514050046586
  2. [2] Beck U. Risikogesellschaft. Auf dem Weg in eine andere Moderne. Frankfurt a.M.: Suhrkamp; 1986 (ed. it.: Beck U. La società del rischio. Verso una seconda modernità. Traduzione di Privitera W, Sandrelli C. Roma: Carocci editore; 2000).
  3. [3] Giddens A. The consequences of modernity. USA: Stanford University Press; 1991 (ed. it.: Giddens A. Le conseguenze della modernità. Fiducia e rischio, sicurezza e pericolo. Traduzione di Guani M. Bologna: Il Mulino; 1994).
  4. [4] Luhmann N. Soziologie des Risikos. Berlin: de Gruyter; 1991 (ed. it.: Luhmann N. Sociologia del rischio. Traduzione di Corsi G. Milano: Bruno Mondadori; 1996).
  5. [5] Rose N. Psychiatry as a political science: advanced liberalism and the administration of risk. History of Human Sciences 1996; 9 (2): 1-23., DOI: 10.1177/09526951960090020
  6. [6] Rogers A, Pilgrim D. A sociology of mental illness: fourth edition. Berkshire: McGrawHill; 2010.
  7. [7] Mullen R, Admirall A, Trevena J. Defensive practice in mental health. Journal of the New Zealand Medical Association 2008; 121 (1286): 85-91.
  8. [8] Schmiedebach HP, Priebe S. Social psychiatry in Germany in the twentieth century: ideas and models. Medical History 2004; 48: 449–472., DOI: 10.1017/S002572730000796
  9. [9] Ricci S. Fogli di informazione terza serie n 31/32 Luglio Dicembre anno XLI 2015; 228-229: 448-499.
  10. [10] Foucault M. Gli Anormali. Milano: Feltrinelli; 2014, p. 110-112.
  11. [11] Priebe S, Badesconyi A, Fioritti A, Hansson L, Kilian R, Torres-Gonzales F, et al. Reinstitutionalization in mental health care: comparison of data on service provision from six European countries. British Medical Journal 2005; 330: 123-6., DOI: 10.1136/bmj.38296.611215.A
  12. [12] Cupelli C. La responsabilità penale dello psichiatra. Sui rapporti tra obblighi impeditivi, consenso e regole cautelari. Napoli: Edizioni Scientifiche Italiane. Collana nuove ricerche di scienze penalistiche 2013; 15.
  13. [13] Monahan J. Predicting violent behaviour: an assessment of clinical techniques. Beverly Hills, CA: Sage Publications; 1981.
  14. [14] Ryan C, Nielssen O, Paton M, Large M. Clinical decisions in psychiatry should not be based on risk assessment. Australasian Psychiatry 2010; 18 (5): 398-403., DOI: 10.3109/10398562.2010.50781
  15. [15] Webster CD, Douglas KS, Eaves D, Hart SD. HCR-20: assessing risk for violence (version 2). Simon Fraser University, Mental Health, Law, and Policy Institute; 1997.
  16. [16] Maden A. Treating violence: a guide to risk management in mental health. Oxford UK: Oxford University Press; 2007.
  17. [17] Burns T, Rugkåsa J, Molodynski A, Dawson J, Yeeles K, Vazquez-Montes M, et al. Community treatment orders for patients with psychosis (OCTET): a randomised controlled trial. Lancet 2013; 381 (9878): 1627-33., DOI: 10.1016/S0140-6736(13)60107-
  18. [18] Hart SD, Michie C, Cooke DJ. Precision of actuarial risk assessment instruments. British Journal of Psychiatry 2007; 190 (suppl 49): s60-5., DOI: 10.1192/bjp.190.5s6
  19. [19] Large MM, Ryan CJ, Singh SP, Paton MB, Nielssen OB. The predictive value of risk categorization in schizophrenia. Harvard Review of Psychiatry 2011; 19 (1): 25-33., DOI: 10.3109/10673229.2011.54977
  20. [41] Borum R, Bartel P, Forth A. Manual for the structured assessment of violence risk in youth (SAVRY): version 1.1. University of South Florida; 2003.
  21. [20] Fazel S, Singh JP, Doll H, Grann M. Use of risk assessment instruments to predict violence and antisocial behaviour in 73 samples involving 24827 people: systematic review and meta-analysis. British Medical Journal 2012; 24: 345:e4692., DOI: 10.1136/bmj.e469
  22. [21] Buchanan A, Leese M. Detention of people with dangerous severe personality disorders: a systematic review. Lancet 2001; 8; 358(9297): 1955-9., DOI: 10.1016/S0140-6736(01)06962-
  23. [22] Large M, Ryan C, Nielssen O. Minority report on violence risk assessment. The Psychiatrist 2012; 36(1): 36., DOI: 10.1192/pb.36.1.3
  24. [23] Szmukler G. Risk assessment for suicide and violence is of extremely limited value in general psychiatric practice. Australian and New Zealand Journal of Psychiatry 2012; 46 (2): 173-4., DOI: 10.1177/000486741143221
  25. [24] Horstead A, Cree A. Achieving transparency in forensic risk assessment: a multimodal approach. Advances in psychiatric treatment 2013; 19: 351-7., DOI: 10.1192/apt.bp.112.01064
  26. [25] Castelletti L, Rivellini G, Straticò E. Efficacia predittiva degli strumenti di Violence Risk Assessment e possibili ambiti applicativi nella psichiatria forense e generale italiana. Una revisione della letteratura. Journal of Psychopathology 2014; 20:153-162.
  27. [26] Andrews DA, Bonta J. LSI-R: the level of service inventory-revised. Multi-Health Systems; 1995.
  28. [27] Hare RD. The Hare psychopathy checklist-revised (PCL-R). Multi-Health Systems; 1991.
  29. [28] Hare RD. The Hare psychopathy checklist-revised 2nd edition. Multi-Health Systems; 2003.
  30. [29] Caretti V, Manzi GS, Schimmenti A, Seragusa L. PCL-R. Hare psychopathy checklist-revised 2nd edition. Versione italiana. Firenze: Giunti O.S.; 2011.
  31. [30] Quinsey VL, Harris GT, Rice ME, Cormier CA. Violent offenders: appraising and managing risk. American Psychological Association; 1998.
  32. [31] Quinsey VL, Harris GT, Rice ME, Cormier CA. Violent offenders: appraising and managing risk 2nd edition. American Psychological Association; 2006.
  33. [32] Harris AJR, Phenix A, Hanson RK, Thornton D. Static-99 coding rules: revised 2003. Solicitor General Canada; 2003.
  34. [33] Hanson RK, Thornton D. Static-99: Improving actuarial risk assessments for sex offenders. Department of the Solicitor General of Canada; 1999.
  35. [34] Webster CD, Eaves D, Douglas KS, Wintrup A. The HCR-20 scheme: the assessment of dangerousness and risk. Forensic Psychiatric Services Commission of British Columbia; 1995.
  36. [35] Douglas KS, Hart SD, Webster CD, Belfrage H. HCR-20V3: Assessing risk of violence – User guide. Burnaby, Canada: Mental Health, Law, and Policy Institute, Simon Fraser University; 2013.
  37. [36] Boer DP, Hart SD, Kropp PR, Webster CD. Manual for the sexual violence risk-20. Professional guidelines for assessing risk of sexual violence. Simon Fraser University, Mental Health, Law, and Policy Institute; 1997.
  38. [37] Kropp PR, Hart SD, Webster CD, Eaves D. Manual for the spousal assault risk assessment guide. British Columbia Institute on Family Violence; 1994.
  39. [38] Kropp PR, Hart SD, Webster CD, Eaves D. Manual for the spousal assault risk assessment guide. 2nd ed. British Columbia Institute on Family Violence; 1995.
  40. [39] Kropp PR, Hart SD, Webster CD, Eaves D. Spousal assault risk assessment guide (SARA). Multi-Health Systems; 1999.
  41. [40] Borum R, Bartel P, Forth A. Manual for the structured assessment of violence risk in youth (SAVRY). University of South Florida; 2002.
  42. [42] Phillips J, Frances A, Cerullo MA, Chardavoyne J, Decker HS, First MB, et al. The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis. Philosophy, Ethics, and Humanities in Medicine 2012; 7:3., DOI: 10.1186/1747-5341-7-
  43. [43] Miller CS, Kimonis ER, Otto RK, Kline SM, Wasserman AL. Reliability of risk assessment measures used in sexually violent predator proceedings. Psychological Assessment 2012; 24(4): 944-953., DOI: 10.1037/a002841
  44. [44] Singh JP, Grann M, Fazel S. Authorship Bias in Violence Risk Assessment? A Systematic Review and Meta-Analysis. PLoS ONE 2013; 8(9): e72484., DOI: 10.1371/journal.pone.007248
  45. [45] Morgan S. Positive risk-taking: An idea whose time has come. Health Care Risk Report 2004; 10 (10): 18–19.

Valentina Moretti, Gian Maria Galeazzi, Risk colonisation. Comments on assessment and risk management of violence in psychiatry in "RIVISTA SPERIMENTALE DI FRENIATRIA" 3/2015, pp. 71-88, DOI:10.3280/RSF2015-003005


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