Valuing the splits and preventing violence
Managing the risk of violence, be it directed toward others or the self, is a central function of an adult psychiatric service. Vital to this process is the risk assessment, which can be a difficult and lengthy process, requiring a methodical approach and space for reflection. This chapter explains how the patient's relationship with clinicians can be used to provide important information which helps produce a more therapeutic, informed service, appropriate to the patient's needs. The semi-structured approach is flexible and accessible for all staff, offering an innovative way to conduct a consultation with a team. It puts the patient at the centre in a practical and acceptable way. A very different picture might be presented, one that corresponds to the patient being a victim of critical and indifferent carers. Such splitting is a defence that protects the patient from the unbearable loss attached to the depressive position.