There might be a temptation, given what Professor Soothill describes in his foreword to Professor Prin's book as the ‘risk industry’, and the way that it continues to grow, to dismiss yet another publication in this area as possibly having little to add to what we already know. That would be to miss the point, not least because the concepts of risk assessment and management in psychiatry are here to stay. In addition, there is almost always something to learn in reading about them and equally, almost always something to reflect upon and even worry about in relation to one's own practice. This book is no exception. Although it covers a wide range of different areas, much of its content will be familiar to many psychiatrists, particularly those working in the forensic field. It is, nevertheless, an easily understood, clear overview of the issues in relation to mentally disordered offenders (MDO) in particular and will be of value to those coming newly to the subject.
The introduction to risk as a general concept is interesting, if rather brief, and is followed by sections that review the work of some historically important Government committees, the functions of the mental health review tribunal and parole board, among others, and describe some of the research into the relationship between violence in its various forms, and mental disorder. Professor Prins brings to the book his own experience of working as a member of two inquiries, and describes certain others chosen, by his own admission, in a somewhat arbitrary manner but included in order to illustrate different points. I suspect that any member of the public, with little or no experience of people with mental illness or any form of mental disorder, who reads this will find it the most disturbing section. Why does it seem that the same sort of errors or omissions are made time and time again?
There might, perhaps, have been a more searching and extensive explanation of the difficulties that arise when attempting to equate the aims of mental health professionals and the criminal justice system in dealing effectively with MDOs, although some of these are raised. There is a description of a fictitious case conference and the participants from some of the various different professional groups who might be involved. Although in some places these caricatures may not be so recognisable, regrettably in others they still represent reality.
I was most anxious to reach the part of the book entitled 'Improving Practice'. Initially I found myself somewhat disappointed, but through no fault of the author. In reading about risk assessment and management one can become possessed by the search for revelation and the ultimate answer to the unanswerable question. We are encouraged by much of what we might see that relates to these areas to believe in the Holy Grail of absolute prevention. What Professor Prins does so successfully is to remind us that there is actually no such thing. Our efforts should be focused on maintaining high standards in relation to the basic elements of practice. We should obtain, record and share information, foster good communication and liaison with all those involved and maintain a degree of suspicion within appropriate professional limits, and ask questions accordingly. Perhaps one of the most important messages that we should be seeking to put across is that for some, death, not only their own but regrettably in some cases that of another person, may be an entirely unpredictable and unpreventable but almost inevitable outcome in certain circumstances.
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