Adrienne Saxton, MD Assistant Professor Department of Psychiatry Case Western Reserve University School of Medicine Cleveland, Ohio
Phillip Resnick, MD Forensic Psychiatry Section Editor Current Psychiatry Professor Department of Psychiatry Case Western Reserve University School of Medicine Cleveland, Ohio
Stephen Noffsinger, MD Associate Professor Department of Psychiatry Case Western Reserve University School of Medicine Cleveland, Ohio
Disclosures The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.
Although certain mental illnesses increase the relative risk of violence (compared with people without mental illness),5,6 recent studies suggest that mental illness plays only a “minor role in explaining violence in populations.”7 It is estimated that as little as 4% of the violence in the United States can be attributed to mental illness.1 According to a 1998 meta-analysis of 48 studies of criminal recidivism, the risk factors for violent recidivism were “almost identical” among offenders who had a mental disorder and those who did not.8
Approaches to assessing violence risk
Psychiatrists can assess the risk of future violence via 3 broad approaches.9,10
Unaided clinical judgment is when a mental health professional estimates violence risk based on his or her own experience and intuition, with knowledge of violence risk factors, but without the use of structured tools.
Actuarial tools are statistical models that use formulae to show relationships between data (risk factors) and outcomes (violence).10,11
