Psychiatric Risk Assessment Does Not Benefit Patients or the Public – BMJ


In a “Head to Head” debate for the British Medical Journal on whether risk assessment in psychiatry “serves the interests of patients or the public”, the respondent for “no” asserts “Risk assessment was not introduced into mental healthcare because of scientific progress but because of complex social and political factors, including media pressure after a small number of catastrophic events… Risk assessment does not work because it lacks the statistical power to discriminate between those who will and those who will not commit particular harms, such as suicide and severe violence…”

Abstract →

Large, M. Does the emphasis on risk in psychiatry serve the interests of patients or the public? No. British Medical Journal 2013; 346:f857 (Published 12 February 2013

Previous articleNo Link Between Teen Depression and Violent Crime
Next articleDSM-5: How the Emperor Got His Clothes
Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. I cannot read the whole article because I don’t have an account. However, the responses are in full sight for everybody to see. One thing that we should thankful of here in the US is an appreciation that one of the responders made

    “These attitudes have negatively affected our concept of patient need to the extent distorting our views on the need for detention under the Mental Health Act. Legally, patients should be detained to hospital if they are suffering from a mental illness which may represent 1) a risk to self, 2) a risk to others or 3) a deterioration of their illness if left untreated. When deciding on which course of action to take, I have been amazed at the number of times that i am met with the question of “why on earth do you want to admit them, they’re not suicidal or homicidal.” It is almost as if we have forgotten about the third criterion completely-we have a duty to provide timely and effective intervention to prevent further deterioration in a patient’s underlying mental illness, IRRESPECTIVE of the presence or absence of risk!!”

    It was under this pretext that I was civilly committed since in all countries of the European Union that is a valid legal pretext to civilly commit one. As you can imagine, given its subjectivity, the end result is that that psychiatry regularly uses it to abuse anybody they want. To compound matters, medical malpractice law in Europe is not as good for those on the receiving end of an abuse as it is here in the US. So psychiatrists regularly abuse people over there pretty much unpunished. Thanks God for the US constitution!

    Report comment