Clinical risk assessment in secure care

This is the first of two linked chapters examining the closely related concepts of risk assessment and risk management in secure mental healthcare. In this chapter, we consider the nature of risk in the context of secure mental healthcare, particularly the risk of physical violence but also that of suicide. We provide an overview of the epidemiology of violence and suicide risk in people with mental disorder. Next, we explain how risk assessment has developed over recent decades. We describe unstructured, actuarial and structured professional judgement methods of violence risk assessment, and discuss two of the main tools used in secure clinical practice. Finally, we review the evidence on risk assessment in relation to specialist or minority populations in secure care including women, those diagnosed with intellectual disability, autism spectrum disorder, Black and minority ethnic groups, adolescents and those in neuropsychiatry services. In Chapter 4 we discuss methods of risk management in the secure setting.