Violence Risk-Assessment and Management: Advances through Structured Professional Judgment and Sequential Redirections

The historical perspective of a book reviewer often affects how he appreciates a scholarly compilation. My earliest memory regarding the assessment of dangerousness occurred during the first week of my internship when the California Supreme Court issued its ruling in the 1976 rehearing of Tarasoff v. Regents of the University of California.¹ This decision was handed down amid concerns of the limited accuracy of assessments of dangerousness as captured by the then often-echoed catch-phrase, “flipping coins in the courtroom.”² Since then, I have witnessed gradual clinical advances in the assessment of dangerousness and violence risks along with the evolving legal and social landscape in which these assessments are performed. The authors of the second edition of Violence Risk Assessment have captured the historical essence of these four decades and describe the current state of affairs for violence risk assessment.

The second edition has added an author from the United Kingdom (psychiatrist Quizi Haque, Honorary Lecturer at the King's College Institute of Psychiatry) to the two Canadian authors from the first edition (psychologist Christopher D. Webster, Professor Emeritus of Psychiatry at the University of Toronto and Professor Emeritus of Psychology at Simon Fraser University and psychiatrist Stephen J. Hucker, Professor of Psychiatry at the University of Toronto). They are well known in the North American forensic mental health community. Relative to the previous edition, the book's focus shifts from the use of structured professional judgment in violence risk assessment to emphasis on the value of violence risk assessment as an essential component of clinical treatment that should guide an individual's treatment plan. In fact, the subtitle of their book, Advances Through Structured Professional Judgment and Sequential Redirection, underscores this additional focus, which is preached throughout the book.

The book has 20 chapters: 16 of them written by Drs. Webster, Haque, and Hucker. The authors summarize the historical development of violence risk assessment, provide a thorough discussion of the identifying various risk factors for violence, and describe the birth and evolution of specific tools that have become an integral part of these assessments, such as the Historical Clinical Risk Management (HCR)-20. There is a review of the usual components of a competent forensic assessment, including the importance of having an adequate database and identifying the type and parameters of the potential harm being assessed. Of note, there is a cautionary discussion about what seems to be a real limitation (or sound barrier) to the predictive accuracy of these assessments, even under optimal conditions. The authors champion the use of structured professional judgment, which tempers the contribution of an assessment tool by considering characteristics and factors that are specific to the evaluee.

The book does a credible job of convincing the reader that violence risk assessment plays an important, if not critical, role in the treatment and management of persons in general, correctional, and forensic mental health systems. The major assets of this book include the historical development of structured professional judgment and the generic description of the risk assessment process. This approach permits programs to use the principles to tailor violence risk assessment to apply to their specific situations. R. Karl Hanson's chapter on assessment of sex offenders is one of the best, if not the best, I have seen on the topic in a single compact chapter, especially in its discussion of the Static-99 and its progeny, the most recognizable of assessment tools used in sex offender evaluations.

Violence Risk Assessment and Management is a compact book that excels in educating and enlightening the psychiatrist-in-training and the seasoned forensic psychiatrist about this important topic. I have waited nearly 40 years for this book.

• © 2015 American Academy of Psychiatry and the Law