ABSTRACT
Assessing risk of recidivism is a critical component of treatment in secure mental health services. It is not enough to treat mental illness and assume risk is ameliorated as a result. In order to implement effective risk management plans and prevent violence, mental health professionals must be alert to dynamic interpersonal factors, which may recur in a patient's circumstances and cause risk to subsequently increase. Various models of causality have been proposed to describe the relationship between risk factors and violence. Causal dynamic risk factors can be categorised as traits, which are chronic and recurring, such as psychosis and drug use, or an acute single event such as extreme arousal. The interpersonal dynamics (ID) consultation is a useful tool for the identification of boundary breaches. In general, major breaches of staff-patient boundaries, such as inappropriate sexual relationships, occur rarely. The ID formulation should be utilised in conjunction with an HCR-20 risk assessment and care plan.
