Clinical judgement in violence risk assessment

Abstract

The present article discusses the three main approaches to violence risk assessment, clinical judgement, actuarial assessment, and structured clinical judgement, informing the reader of the comparative benefits and short-comings of these methods of violence risk assessment. In particular, the present article highlights the controversy within the literature surrounding clinical judgement in comparison to actuarial assessments of violence risk, and proposes that the statistically significant ‘improvements’ of violence prediction when using actuarial scales in comparison to clinical predictions of dangerousness do not necessarily measure the skill of the clinician adequately. Specifically, an assessment of ‘dangerousness’ does not equal a prediction of violent recidivism. It is argued that clinicians are not predictive forecasters of risk, as in actuarial scales, but are, rather, trained to manage risk. In addition, suggestions for future research directions in the field of improving violence risk assessments are made.