Assessing and managing risk to others is fundamental to the practice of mental health professionals in forensic services. The need for clear structured approaches to risk assessment that are based on research evidence has become more prominent in recent years (Royal College of Psychiatrists, 2008; Department of Health, 2007 ). In mental health services, there has been increasing concern in relation to violent behaviour. A relatively small, yet signiﬁ cant number of incidents involving people with mental illness have received considerable media attention (e.g. Ritchie et al. , 1994 ; NHS London, 2006). This has left a strong impression of the potential dangerousness to the public from individuals with various forms of mental disorder. This is fuelled by ﬁ ndings that patients recently in contact with mental health services commit around 9 per cent of all homicides in England and Wales. These ﬁ gures translate to 52 homicides per year, of which 30 are committed by people diagnosed with schizophrenia (National Conﬁ dential Inquiry, 2006). Perceived failures support the widely-held perception of inadequate service provision and the growing concern that the public are not adequately protected from dangerous individuals by current legislation and practice.