Allen J
Nottingham Healthcare Trust, UK.
J Psychiatr Ment Health Nurs. 1997 Oct;4(5):369-78. doi: 10.1046/j.1365-2850.1997.00068.x.
This review paper explored the concepts of risk assessment and management in relation to 'serious' violence by individuals with mental disorder. The paper highlighted the political context in which concern over serious violence by those with mental disorder is increasing. Government guidance on risk assessment was considered and identified as having an actuarial bias. Correlational studies, which provide actuarial indicators of risk, were explored and a picture was developed that demonstrated the difficulty of determining risk of violence to others simply on the basis of psychiatric symptomatology. The literature led to a conclusion that risk assessment for violence is an inexact science, and that actuarial indicators need to be supported by structured thorough clinical investigation. Legal concerns around the assessment and management of risk were also explored. The Health and Safety Executive model for risk management was explored in relation to the findings of the risk-assessment literature and the recommendations of reports into serious violent incidents. The model was shown to have potential utility in providing a legally sound framework for the assessment and management of risk of violence in mental disorder.
这篇综述论文探讨了与精神障碍患者“严重”暴力行为相关的风险评估和管理概念。该论文强调了这样一种政治背景，即对精神障碍患者严重暴力行为的担忧正在增加。文中考虑了政府关于风险评估的指导意见，并指出其存在精算偏差。对提供风险精算指标的相关性研究进行了探讨，并形成了一种观点，即仅根据精神症状来确定对他人的暴力风险是困难的。文献得出的结论是，暴力风险评估是一门不精确的科学，精算指标需要得到结构化的全面临床调查的支持。还探讨了围绕风险评估和管理的法律问题。结合风险评估文献的研究结果以及针对严重暴力事件报告的建议，对健康与安全执行委员会的风险管理模型进行了探讨。结果表明，该模型在为精神障碍患者暴力风险的评估和管理提供一个法律上合理的框架方面具有潜在效用。
