CHAPTER 7 Risk assessment and management Steve Turner Introduction ‘Risk assessment’ is a risky term. Taken at face value, it encourages a number of misconceptions and simplifications. It is easy, but dangerous, to assume that risk is always detrimental, that it is always quantifiable and stable, and that assessment is always scientific, unbiased and valid over time. In order to explore some of these issues further, this chapter will examine the concepts of risk and dangerousness, and what is meant by assessment. It will then continue with a review of recent work in both learning disability and mainstream psychiatric research, presenting some of the ways in which agencies have interpreted risk assessment and manage- ment in a range of different settings. Finally, the chapter offers guidance relating to risk assessment and management in practice. Background The growing interest in risk assessment in forensic learning disability services is in great part a product of the deinstitutionalisation movement, which has seen the numbers of people with learning disabilities living in specialist hospitals in England decline from 49 200 in 1969 to 8200 in 1998. 1 The Committee set up to review health and social services for mentally disordered offenders and others requiring similar services heard evidence that ‘one effect of contemporary service patterns was to expose more of the intellectually disabled population to the risk of offending’. 2 Consequently, service providers have come under increasing pressure to measure and control these risks. As a result, risk assessment and management represents one of the growth areas in forensic practice both in mainstream psychiatry and in learning disability services. 3  Introduction  Background  The basis of risk assessment  Risk assessment in practice  Conclusion 121