Risk assessment in a multi-disciplinary forensic setting: clinical judgement revisited

The changing fortunes of clinical approaches to risk assessment in the forensic and mental health fields are reviewed. A prospective study of medium-term clinical risk forecasting in a forensic setting is described, using receiver operating characteristics (ROC) to evaluate the judgements of the multi-disciplinary teams. The accuracy of consensus predictions of patient-related risks was found to be comparable with actuarially based studies over similar time-scales, although some low base rate events eluded prediction. The study reasserts a role for clinical judgement in risk assessment;but recognizes that evaluation of risk assessment activity in care settings is methodologically confounded by subsequent risk management interventions. Studies of how clinicians proceed from the former process to the latter may prove a more fruitful direction for future research in forensic settings.