La colonizzazione del rischio. Note sulla pratica della valutazione e gestione del rischio di violenza in psichiatria [Risk colonisation. Comments on assessment and risk management of violence in psychiatry]

The last decades have seen a growing interest in the topic on violence risk assessment and management for mentally disordered offenders. More and more often, professionals are requested to assess and manage this risk, in a process which could be defined as “risk colonisation”. In this context, a number of structured risk assessment tools have appeared, which claim to allow to take complex decision, such as those concerning the application of coercive measures, in a reliable and precise manner. We express our doubts on this practice, not limited to ethical issues, highlighting the technical shortcomings of these tools, in particular their insufficient positive predictive value, and some limits of the model of mental health and of patient-professional relationship their adoption often corresponds to. We hope professionals adopt instead a therapeutic risk taking stance, involving the coproduction of shared goals users and professionals contribute to in the context of a supporting team-user relationship. This means to share human, professional, and advocacy skills, involving other appropriate agencies and stakeholders, so that these goals are attained in a context which is sufficiently safe and responsive to needs.