Challenges and Uncertainties in Violence Risk Assessment: A Critical Examination of Practice and National Guidelines in Norway's Specialist Mental Health Services

Abstract

In recent years, there have been several serious incidents in Norway where individuals with serious mental disorders have committed murder after being discharged from psychiatric care units. Several of these incidents have been subject to scrutiny by governmental oversight bodies and have sparked significant societal debates.The Norwegian Directorate of Health recommends the implementation of structured clinical violence risk assessments for patients with severe mental disorders being considered at risk of conducting violence. Reports from oversight authorities have highlighted instances where either violence risk assessments were not conducted prior to patient discharge or where assessments were inadequate. Violence risk assessments in mental health care remain a highly debated topic among professionals. This paper does not explore whether violence risk assessments are appropriate for use in violence prevention efforts or the quality of various assessment tools. Through the analysis of oversight reports and other documents, shortcomings, and errors in the assessment of violence risk in specialized health services are identified, often attributed to lack of expertise and time constraints. This paper questions how incorrect use of violence risk assessment tools can increase uncertainty and how there may be a potential gap between national professional guidelines for violence risk assessments and actual practice. Therefore, it argues for a thorough investigation to evaluate the need for revision of national guidelines or implementation of measures to ensure that clinicians have the necessary expertise and resources to conduct violence risk assessments.

Keywords: Risk assessments, Risk Management, homicide, Uncertainty, Mental disorder, Norway

DOI: 10.54941/ahfe1004833