Psychiatric Bulletin (2001) 25: 197-198. doi: 10.1192/pb.25.5.197-b
© 2001 The Royal College of Psychiatrists
Psychiatric Bulletin (2001) 25: 197-198
© 2001 The Royal College of Psychiatrists
Will they do it again? Risk Assessment & Management in Criminal Justice and Psychiatry
By Herschel Prins
Martin Humphreys, Senior Lecturer in Forensic Psychiatry
University of Birmingham, Reaside Clinic, Birmingham Great Park,
Birmingham B45 9BE
London: Routledge. 1999. 171 pp. £15.99 (pb). ISBN: 0-415-16018-9
There might be a temptation, given what Professor Soothill describes in his
foreword to Professor Prin's book as the ‘risk industry’, and the
way that it continues to grow, to dismiss yet another publication in this area
as possibly having little to add to what we already know. That would be to
miss the point, not least because the concepts of risk assessment and
management in psychiatry are here to stay. In addition, there is almost always
something to learn in reading about them and equally, almost always something
to reflect upon and even worry about in relation to one's own practice. This
book is no exception. Although it covers a wide range of different areas, much
of its content will be familiar to many psychiatrists, particularly those
working in the forensic field. It is, nevertheless, an easily understood,
clear overview of the issues in relation to mentally disordered offenders
(MDO) in particular and will be of value to those coming newly to the
subject.
The introduction to risk as a general concept is interesting, if rather
brief, and is followed by sections that review the work of some historically
important Government committees, the functions of the mental health review
tribunal and parole board, among others, and describe some of the research
into the relationship between violence in its various forms, and mental
disorder. Professor Prins brings to the book his own experience of working as
a member of two inquiries, and describes certain others chosen, by his own
admission, in a somewhat arbitrary manner but included in order to illustrate
different points. I suspect that any member of the public, with little or no
experience of people with mental illness or any form of mental disorder, who
reads this will find it the most disturbing section. Why does it seem that the
same sort of errors or omissions are made time and time again?
There might, perhaps, have been a more searching and extensive explanation
of the difficulties that arise when attempting to equate the aims of mental
health professionals and the criminal justice system in dealing effectively
with MDOs, although some of these are raised. There is a description of a
fictitious case conference and the participants from some of the various
different professional groups who might be involved. Although in some places
these caricatures may not be so recognisable, regrettably in others they still
represent reality.
I was most anxious to reach the part of the book entitled 'Improving
Practice'. Initially I found myself somewhat disappointed, but through no
fault of the author. In reading about risk assessment and management one can
become possessed by the search for revelation and the ultimate answer to the
unanswerable question. We are encouraged by much of what we might see that
relates to these areas to believe in the Holy Grail of absolute prevention.
What Professor Prins does so successfully is to remind us that there is
actually no such thing. Our efforts should be focused on maintaining high
standards in relation to the basic elements of practice. We should obtain,
record and share information, foster good communication and liaison with all
those involved and maintain a degree of suspicion within appropriate
professional limits, and ask questions accordingly. Perhaps one of the most
important messages that we should be seeking to put across is that for some,
death, not only their own but regrettably in some cases that of another
person, may be an entirely unpredictable and unpreventable but almost
inevitable outcome in certain circumstances.
