Forensic

Risk
Assessment
SRUTHIRAJ M K
MPhil (Forensic Psy), PGD
(Criminology & Forensic),
MSc (Applied Psy)
Table of contents
01. 02.
Risk Assessment & Mental Illness &
Law Violence
History & Development Link b/w mental illness & violence

03. 04.
What is Forensic Risk Identifying Risk &
Assessment? Protective Factors
Risk assessments in forensic Factors associated with future
context violence
Introduction
Psychologists is to predict an
individuals risk for violence. The
decisions that are made by
psychological practitioners
about the disposal of offenders
may increase the chances of
public becoming victims.
Risk Assessment is the process of identifying
and evaluating the likelihood of a person
committing a crime or engaging in other
harmful behaviors.
It is often used in evaluating “individuals who
have violated social norms or displayed bizarre
behavior, particularly when they appear
menacing or unpredictable”
01.
Risk Assessment
& Law
Risk Assessment &
Law
• The need to protect
society
• The need to protect the
rights of possibly
dangerous individuals
Duty to Warn

“No one commits

a crime without
thinking about
it first….”
Tarasoff Case
Tatiana Tarasoff was a UC Berkley student
in 1969. Her ex-boyfriend, Prosenjit
Poddar told a University psychologist he
planned to kill Tatiana. The psychologist
notified the police who could not locate
her & did not follow up. Poddar murdered
Tatiana & her family sued the University
claiming the victim should have been
warned by the psychologist as well. The
family won, laying the foundation for the
"Duty to Warn“ or “Tarasoff Duty” law.
Law of Duty to Protect
● The duty to warn is a legal obligation
for mental health professionals to
protect individuals who are being
threatened with harm by a patient.
○ The duty to warn originated from
the landmark case of Tarasoff v.
Regents of the University of
California (1976).
Duty to Protect Law
1. Warn the Target
• Overrides the confidential
character of clinician client
communication
• Clinicians should notify the
threatened individual

2. Take “responsible” steps to protect

the target
• May include notifying 3rd parties
such as law enforcement
In order to trigger the duty to warn, the
mental health professional must meet
the following requirements:

• The patient must have made a specific

threat of violence against a specific

• victim.
The mental health professional must
believe that the patient is capable of

• carrying out the threat.

The victim must be reasonably
identifiable.
The Mental Health Act,
1987,
requires mental health
professionals to take
steps to protect the
safety of others if they
believe that a patient is
a danger to themselves
or others.
02.

Mental Illness
& Violence
Mental Illness &
Violence

Mental
Violence
Illness
Role of Mental Illness
● Initial Thinking Highly
correlated with violence

● Early research base rates

same as general population

● Most recent research increased

role of certain mental illnesses

● Thought-control override
“There is no consistent evidence that
the true prevalence rate of criminal
behavior among former mental
patients exceeds the true prevalence
rate among the general population
matched for demographic factors and
prior criminal history”
Monahan & Steadman (1983)
Clinical assessment of violence are
complex
● Complicated by the presence of other factor
that increased the odds for violence

● Thus, mental illness did not initially appear

to be a relevant predictor for violence

● Critics of this theory assert that the data

was likely inadequate and could not truly
rule out an association between the two
constructs

Monahan & Steadman (1983)

1990s – association between mental
disorder and violence began to be
acknowledged by researchers

Monahan & colleagues changed

former statements slightly after
conducting MacArthur Violence
Risk Assessment study
o Violence among individuals with mental
disorders mostly explained by other
factors

MacArthur VRA study (1992-1995)

 Other Risk Factors
Gender Personality
Being male is a risk
Disorder Diagnosis
Antisocial personality disorder/
factor
Borderline personality disorder

Past Violence Substance Use

Stronger predictor for Alcohol/ drug abuse
future violence

Childhood
Psychopathy
Victimization
Physical/ sexual abuse Psychopathic triats such as
in childhood lack of empathy
 Psychosis Co-occuring
● Paranoid thinking
● Anger
● Command
● Recurrent
hallucinations
violent
compelling the
ideation
individual to harm

Factors increase odds for Violence

Psychosis can link Mental illness & Violence
People absent
of psychosis

People with
psychosis
49%-68% odds of
violence increase
Douglas, Guy, & Hart (2009)
 Odds of Violence

Hallucinations

2.32
Positive
Symptoms
Delusions
Psychotic

Blunt affect

1.32
Negative Poverty of speech
Apathy
 Symptoms
may motivate
violence!
Specific psychotic symptoms may be
related to violence in several
different ways
 Psychosis symptoms
related to violence

Delusions Hallucinations
● RIGID BELIEFS: persecutory/ ● COMMAND HALLUCINATIONS
conspiracy-based ● Degree of compliance depends on
Risk of these symptoms
○ Violence is acceptable to redress different factors:
○ Identity of voice
grievances
exponentially increases
○ Violence is often well-planned &
goal-directed at a specific target
○ Severity of command
○ Emotional reactions to

●
when individuals report
THREAT TO CONTROL OVERRIDE
commands
○ Level of insight & ability to cope
Violent
○ Belief external agent
them harm
is causing Fantasies ○ How powerful the obligation is to
act on command
○ External forces controlling
themselves
Functional Analysis of
Exploration
1. Which symptoms are displaying? Recommended
2. Under which circumstances do symptoms Professionals conduct their own
appear? functional analysis of how
evaluee’s symptoms may prelude
3. Moderated by which other factors? violence.

4. Role moderators play with behavior?

5. Likely target of violent behavior?

Final Caveats
Psychosis is not a necessary/
sufficient condition to
increase the risk for
violence.

Legal repercussions &

potential stigmatization of
concluding that a person
with severe mental illness is
at risk for violence.
 Psychopathy &
Anti-Social Personality
Stronger predictors for
violence
 Comorbid
Substance Use
Substantially elevate violence risk in
individuals with psychosis
Thus heavier weight given to this
when assessing & designing
management plan
 Treatment
Engagement
Lack of treatment engagement may
lead to seeking alternatives &
cause a relapse
Whoa!
Can we mental health professionals
predict future violence?
➢ We are no good at it!
Legal
Perspective
The legal professionals
skepticism about the mental
health professionals ability to
predict dangerousness was
highlighted in 2 cases:

● Barefoot v. Estelle (1983)

● Boynton v. Burglass (1991)
Barefoot V. Estelle
(1983)
• Supreme court stated that a mental
health professional could address the
issue of future dangerousness of a
capital murder defendant at the
sentencing portion of a trial.

• The APA filed an amicus brief in this

case which noted that 2 out of 3
predictions are made by
psychologists where eventually
proven wrong.
Boyton V. Burglass
(1991)
The court stated “when the duty
sought to be imposed is dependent
upon standards of the psychiatric
profession were asked to embark
upon a journey that quote will take
us from the world of reality into the
Wonderland of clairvoyance”
03.

What is
Forensic Risk
Assessment?
In criminal and juvenile
justice systems, the
results of risk
assessment often play a
significant role in
decisions made by the
courts regarding bail
and sentencing.
Forensic psychologists
are very often asked to
predict the likelihood
that a particular
individual will be
“dangerous” to
themselves orForensic
This is known as to risk
[Link].
 Forensic risk assessment, also
frequently referred to as Violence
Risk Assessment, attempts to
predict the likelihood that an
individual will commit a violent or
anti-social act.
Through forensic risk assessment,
forensic psychologists work to
ensure the proper preventative
interventions are made to keep
prison populations and society
safe.
 A major undertaking for
forensic psychologists
is to conduct risk
assessments, more
specifically violence risk
assessments, which are
then communicated to
representatives of the
legal system.
Risk assessment is important in
forensic psychology because
it can be used to:

• Identify individuals who are

at risk of re-offending or
harming others
• Develop treatment plans to
reduce risk
• Make decisions about
sentencing, parole, and
release
 The assessment and
management of the risk
of violence are core issues
revolving around the
interface of law and
mental health
Clinical Risk Forensic Risk
Assessment Assessment
● Clinical Assessment ● Referral from court
● Treatment is the goal ● Treatment may not be goal
● Clinical ethics plays ● Forensic ethics plays
crucial (confidentiality)
● Time constraints is ● Time constraints may there
usually not there ● Assessment for legal
● No court summon proceedings
● Technical language issue ● Expert testimony
● Patient safety ● Simple language for court
● Public safety
04.
Identifying
Risk & Protective
Factors
What is Risk?
• Risk is viewed as a range
(Steadman, 2000)
o Probability of an event
that may or may not
occur
o Likelihood of something
happening
• Risk assessment has 2
components:
o Prediction
o Management
Risk of Harming
Others
● Violence towards others (such as
family members, friends,
colleagues, public etc.)

● Sexual assault on children/women

● Domestic violence

● Aggression towards particular

organization, community , or
country

● Public nuisance
(shouting/disrobing/masturbating)
Risk of Harming
Self
● Substance use

● Suicidal attempt

● Financial harm
(shopping/gambling)

● Disinhibited behavior/
risk of contractings
Risk of Destroying
Property
● Vandalizing public
property / vehicles

● Vandalizing private
property/ vehicles

● Religious places (at the

verge of erupting to
communal violence)
 There are a number
of factors that can
increase or decrease
the risk of an
individual engaging
in harmful or
dangerous behavior
These factors can be divided into
two categories: Risk factors &
Protective factors
Risk Factors
Risk factors are characteristics or
experiences that increase the
likelihood of an individual
engaging in harmful or
dangerous behavior.
Such as history of violence,
history of substance abuse,
mental illness
exposure to violence or
abuse.
Past History is the
best predictor
● Age
What
➢ isat
the1stmost
arrest highlythink they
violent
correlated
have ever done?with criminality
● ➢ Each
Type prior episode
of behavior, why it occurred,
whoincreases risk intoxication,
was involved,
degree
➢ Fourof injury arrests the
previous
● probability
Criminal of 5threcords
and court is 80%
Risk Factors
● Static Factors – Historical
Predictors

● Dynamic Factors –
Fluctuating factors

● Risk Management
Factors- Relative Stable
Factors
Static Factors
➢ Demographic details- age, gender
➢ Death of loved one
➢ ●Past history of illness/substance/
Happened in the past/ drug
abuse
➢ Past history of
cannot conflict with law
change
➢ History of poor compliance to treatment
➢ ●Family
May history
speak of mental
to theillness
➢ Child sexual abuse/pedophile
➢ Incurable illnesslifetime
absolute, (cancer,/HIV/head
risk
injury)
➢ Personality disorder (ASPD, BPD,
Paranoid)
➢ No empathy
Dynamic Factors
●
✓Can
Psychiatric
changeillness factors
(delusions/hallucinations)
● ✓May speak
Access to the relative,
to victim
✓ Access to weapon/drugs
✓short term/ current risk
Employment
●
✓2 Awareness
types: & training of the
personnel
■ Stable-
✓ Environment/ change slowly
relationships
✓ Stressors
■ Acute- change quickly
✓ Supervised medication
✓ Legislation facilitating treatment
Relatively Stable
Factors
● Marriage
•● Finance
Risk management factors
● Insight
refer to characteristics or
● Attitude about violence, women,
variables
children that are relatively
● Substance/
stable and candrugbedependence
influenced
●
toSocial/ family support
mitigate risk.
● Anger disposition
•● Contact
Post with treatment
treatment provider
environment
● Relationship issues
●
isMental
crucial.
illness
Protective Factors
Some examples of protective
Protective
factors factors are
include:
✓characteristics or
Strong social support
✓experiences that decrease
A positive relationship with a
the likelihood
parent of an
or caregiver
✓individual engaging
Good school in
performance
✓harmful or dangerous
Participation in
behavior.
extracurricular activities
‘Risk Management’ aims to
‘Risk Assessment’ is an
minimize the likelihood of
estimation of the
adverse events within the
likelihood of particular
context of the overall
adverse events occurring
management of an
under
individual, particular
to achieve the
bestcircumstances within
possible outcome, anda
specified
deliver safe,period of time
appropriate,
effective care.
 Risk assessment
Earlier is done to
mental health
balance between
legislation

Rights of to
‘dangerous persons
self orwith
others’
…
But now Vs it is
Rights of others
‘risk to the community
or self’ at
large
 Thank You!
Do you have any questions?
benny@[Link]
+91 8884488035
[Link]