Introduction: Risk assessment occupies an increasingly important position in psychiatry. This paper contends that collective judgement is the optimal method of assessing risk.
The meaning of risk: Risk has a dual meaning: emotional and judgemental.
Risks faced by staff: Assaults, threats and survival anxiety.
The effects of danger on the group: Staff wariness and resistance, attribution of blame.
The ambiguous task: For a group to function well it must have a clear task. Custodial roles can lead to ambiguity.
The emotions of larger groups: Externally directed hostility, internal homogenization of views.
Social defences: Rituals can develop in forensic institutions, as well as militarism. ANTI-THERAPEUTIC CULTURE: Sadism may develop where a marked power differential develops.
The role of the leader: Danger intensifies the feelings about leaders, perhaps idealization, perhaps disaffection. Leaders and others need to agree on risk assessment or fragmentation will occur.
The modification of risk: The assessment of risk may modify it. Mutual hostility must be reduced. Dialogue and understanding are needed.
A climate for risk assessment: The environment should be less authoritarian and more democratic, so that patients can join a group and internalize its values. Reflective space is also required.
Conclusions: Risk assessment is best described in terms of human endeavour, not in the language of scientific measurement.