[Risk management of violence: a core professional activity of every psychiatrist].

BACKGROUND: Risk management is an entrustable professional activity in the Dutch curriculum for psychiatrists in training. However, many psychiatrists feel they lack the training and experience needed to conduct an adequate risk assessment of violence.

AIM: Theoretical reflection on methods and practical techniques to adequately assess violence in patients with severe mental disorders.

METHOD: Review of the international literature to deliver recommendations for (non-forensic) clinical practitioners.

RESULTS: Risk assessment starts with contact and a trusting therapeutic relationship, followed by a thorough mental health evaluation, screening questions to explore thoughts and history of harming others, and examination of predisposing, triggering and sustaining risk and protective factors, and warning signs. Structured tools can help to ensure that all critical items are addressed. Risk management should be incorporated whenever indicated in a treatment and safety plan, aimed to the patient’s struggles and suffering in interpersonal functioning.

CONCLUSION: Violence is an important adverse outcome in clinical services for patients with severe mental illness. Risk management of violence, integrated in the general diagnostic process and treatment plan, contributes to compassionate mental health care, and increase safety of family members, fellow patients, health professionals, and others.