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Risk assessment by mental health professionals and the prevention of future violent behaviour

Abstract

This is a report on a research project partially funded by the Criminology Research Council. The original title of the project, in the name of Dr Bernadette McSherry and Professor Paul Mullen, was 'Risk assessment by mental health professionals and the prevention of future violent behaviour'. The report examines the current legal and ethical background to risk assessment for the purpose of preventing future serious injury to others. It outlines the development of the concepts of risk assessment and risk management and the different ways in which risk can be measured. It now appears that there is some degree of consensus that well-trained mental health professionals should be able to predict a patient's short term potential for violence. The report also sets out the forensic context for risk assessment and outlines some of the areas of law where mental health professionals may be required to write reports or give evidence concerning risk of harm to others. In the criminal law field, this includes writing reports in relation to the risk of an accused re-offending for the purposes of bail applications, sentencing and preventive detention, the disposition of offenders with mental disorders and parole. The report then turns to legal and ethical arguments relating to breaching confidentiality when a health professional believes a patient is at risk of harming others. While there are strong ethical justifications for preserving confidentiality, it appears that the majority of health professionals and ethicists view confidentiality as being relative rather than absolute. There is a dearth of case law on the subject in Australia, but the developing common law in England, New Zealand and Canada on the public interest exception to confidentiality has set out some guidelines in the forensic setting that may also be appropriate in the therapeutic context. The report also includes a questionnaire sent to Victorian psychologists and psychiatrists, which aimed to identify the main factors influencing mental health professionals' assessment of the risk of future violent behaviour and when they will breach confidentiality, as well as the results from the returned questionnaires. (Author abstract, edited).

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