ABSTRACT
This chapter considers ways of reducing risks of escalation of violence and of coping with tragedies. With psychotic patients who present a considerable challenge in determining the risk of potential violence, the violent act might be towards a complete stranger. While risk assessment takes place every time a patient with a history of psychosis is seen clinically, in two particular settings this is the central feature of the proceedings: when assessing the grounds for a formal hospital admission, and when a hospital tribunal is considering whether it is safe to lift a restriction order. Risk assessment remains based at a clinical level, each case having to be considered on its own merits. Patients with psychotic disorders project and disown their problematic states of mind, especially when relapsing. Patients in psychotic states tend to fragment and project their feelings, and different people pick up different bits, like pieces of a jigsaw puzzle.
