Clinical Risk Management

An important area of research regarding violence prevention is the evaluation and development of models for the assessment and management of risk and threat. With regard to forensic mental health assessment and care, this involves the refinement of risk assessments that form the basis of decisions concerning parole, leave and discharge from forensic mental care. For the prison and probation service, which handles over 50,000 requests for leave annually, there is an equivalent need for skills development. The police also have to evaluate threats on a daily basis, often in acute situations where quick assessments are crucial to making the correct decisions regarding detention and intervention or, for example, increasing presence during demonstrations and sporting events. The costs of wrong decisions are high.

Risks that go undetected can lead to violent actions, such as a reoffence during leave. In addition to the suffering of the victim, this incurs costs for the perpetrator as well as in terms of a loss of confidence in the authorities and an increase in the general public's fear of violence. A cautious strategy takes all risks and threats very seriously, but advocates of this do not always consider the costs in terms of prolonged periods of care, increased deprivation of liberty and the large-scale security arrangements that would be required. Violence prevention certainly does not have unlimited resources to hand.

During the 1990s, a host of structured models for risk assessment were launched. The perhaps most well known of these in Sweden is a Canadian manual called HCR-20. Structured Outcome Assessment and Community Risk Monitoring (SORM), a model developed by us at Karolinska Institutet, has also gained renown.

The empirical evaluation and development of these models has been, and continues to be, an important objective within the area. A key issue in this context has been the debate on the appropriateness of strict so-called actuarial models (highly structured models that do not contain any elements of clinical appraisal) or so-called structured clinical models (less rigid models which are more similar to clinical checklist). There is at present an important shift from research on the pure assessment of risks (prediction) to research on how to handle risks (management).

This study group, Clinical Risk Management, leads and co-ordinates research and development projects aimed at clinical risk management.

Scientific Theme Coordinator: Mats Dernevik.