© 2009 The Royal College of Psychiatrists
How to make good-enough risk decisions
Andrew Carroll is a senior lecturer in forensic psychiatry at Monash University in Australia, where he coordinates the graduate programme in forensic behavioural science. He is also a consultant forensic psychiatrist at Forensicare’s community forensic mental health service in Melbourne, Australia. His major research interest is the relationship between psychotic illness, social cognition and violence.
Correspondence: Correspondence Dr Andrew Carroll, Centre for Forensic Behavioural Science, Monash University, 505 Hoddle Street, Clifton Hill, Victoria 3068, Australia. Email: andrew.carroll{at}med.monash.edu.au
Making decisions in the context of risk is an integral part of psychiatric work. Despite this, decision-making skills are rarely systematically taught and the processes behind decisions are rarely made explicit. This article attempts to apply contemporary evidence from cognitive and social psychology to common dilemmas faced by psychiatrists when assessing and managing risk. It argues that clinical decision-making should acknowledge both the value and limitations of intuitive approaches in dealing with complex dilemmas. After discussing the various ways in which clinical decision-making is commonly derailed, the article outlines a framework that accommodates both rational and intuitive modes of thinking, with the aim of optimising decision-making in high-risk situations.