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Uncertainty and risk assessment

Mandy Dixon is a freelance researcher whose interests include risk assessment, mental health legislation and the use of qualitative approaches to understanding mental health issues. Femi Oyebode is Professor of Psychiatry and Head of Department of Psychiatry at the University of Birmingham (Queen Elizabeth Psychiatric Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2QZ, UK. Email: Femi.Oyebode{at}sbmht.wmids.nhs.uk). A Member of Council of the Medical Defence Union, his interests include medical negligence, clinical risk management and mental health legislation.

Risk assessment forms an integral part of clinical practice. Traditionally, risk has been portrayed as a binary concept, and its assessment regarded as a test that can be correctly or incorrectly classified. However, this article discusses how risk assessments are less straightforward than is commonly perceived and are often complicated by multiple forms of uncertainty. These uncertainties arise where psychiatrists are unsure about their interpretation of information, where information is missing, or where interpretation of the risk situation is open to challenge. They centre on doubts about the accuracy and the defensibility of assessment of patients’ risk status and the need for risk containment. Like other professionals, psychiatrists adopt a range of strategies to resolve uncertainties. These strategies, which often involve some ‘risk-taking’, enable the practising clinician to make a more confident decision. There is an argument for including ‘certainty’ as a theoretical feature of risk assessment in psychiatry and for recognising it as a multifaceted phenomenon. There is also an argument for considering with greater precision the manner in which uncertainty is managed within psychiatric risk assessments.

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