Commentary: the value of the clinical interview.

The potential for violence among hospitalized psychiatric patients is not a new phenomenon. Risk prediction in hospitalized psychiatric patients requires, in addition to actuarial tools, a firsthand understanding of the patient's psychiatric disorder, symptoms, personality structure, coping skills, and defense mechanisms. The current state of psychiatric hospital care and treatment of mental illness appears to have arrived at such a point that some hospitals are inadequately staffed and unable to provide sufficient time for clinicians to interview newly admitted patients and gain as much information as possible. If an admission is meant to provide some treatment beyond rapid pharmacological stabilization, then there must be, beginning with admission, someone with the time, interest, and skill who talks with the patient to understand his problems and helps guide the subsequent treatment approach through to discharge. The author suggests that risk assessment and treatment, rather than risk prediction and management, should be the goals of hospitalization.