ABSTRACT
For more than a decade the authors of this chapter have been engaged in devising and testing a particular approach to risk assessment and management, the ShortTerm Assessment of Risk and Treatability (START).1 This scheme, which is within the structured professional judgment (SPJ) paradigm described in Chapter 89, is designed to evaluate multiple inter-related short-term risks, to assess clients’ vulnerabilities and strengths, to take account of clients’ particular risk-related idiosyncrasies in thinking and behavior, and to encourage formulation of a treatment plan. By short-term we mean periods ranging from 24 hours to 3 months. Although START provides many concepts that can be supported clinically and scientifically, it cannot be expected to cover all the needs of psychiatrists and other clinicians working in general and forensic mental health and correctional services. Assessing risk for violence over the very short term (i.e., a several hours, 1 day, 1 week, 1 month) is very different from assessing risk for violence over a long-term period (i.e., 5 to 10 years).
