ABSTRACT
Dangerousness and madness have long been linked in the collective imagination, inspiring film and literature, fuelling the media and providing both fascination and fear for the general public. Although there is only a slightly increased, albeit significant, risk of violence amongst people with more serious mental disorders (Taylor and Estroff, 2003), in recent years, considerations of risk have become of central importance to all those working in the field of mental health. The closure of the old mental asylums and release of patients into a community that was insufficiently equipped to contain them, resulted in some highly publicized failures of community care in which serious incidents occurred (Reed, 1997). The ensuing public inquiries condemning the inadequate assessment of patients and the poor communication amongst the mental health professionals and other agencies involved, have created a culture of blame in which politicians and public alike appear more concerned with public protection than with the individual rights of the mentally ill patient. The waters become even muddier when the offender’s mental state and behaviour do not fit neatly into a psychiatric 60diagnostic category but are attributed to an abnormality of character. Public outrage over sex-offenders and so-called “dangerous severe personality disorder” have contributed to the recent proposals for legislation requiring psychiatrists to forcibly detain people who may commit some dangerous act in the future but have not done so yet. Understandable though these anxieties might be, they have the capacity to seriously damage progress towards less authoritarian and custodial mental health services. This is of relevance not only in the forensic mental health services but in all mental health and psychotherapeutic practice.
