Abstract
The good thing about this book is that it conveys informative and instructive material in a compact and readable format. The detraction for Australian and New Zealand readers is that it is written almost entirely from the United Kingdom's perspective. The author acknowledges the plethora of other recent works that deal with dangerousness, or risk, and its assessment but asserts that this is an ‘attempt to place such specialist treatment within a broader conceptual context of risk in modern society’. The ‘society’ is that of the United Kingdom, but many of the author's comments and conclusions are relevant to the mental health services in which we practice. The book considers the personality disordered as well as those suffering more narrowly defined mental illness. The references cited are up-to-date and the notations provide relevant additional detail.
The book opens with a brief chapter which endeavours to place perceptions of risk in a general context. The second chapter deals with legislative and administrative procedures that have developed in relation to mentally disturbed offenders, highlighting just how complex a system can result from the introduction of a range of reactive responses driven by political expediency in the face of a critical media. This is followed by a chapter bringing together research on the association between various categories of mental disturbance and offending; with illustrative case examples and quotations from influential reports which seek to lessen the demonisation that has at times accompanied findings of increased risk associated with mental disturbance. The main impact of the book lies in chapters five and six which provide summaries of a number of inquiries into isolated events, their recommendations, and how these may be usefully incorporated into practice. While recognising the ubiquitous finding of a lack of resources, Prins is also at pains to point to problems that do not result just from a lack of resources, but also flow from the hierarchical and discipline-specific nature of services involved in the care of the mentally disturbed. This is particularly so in relation to mentally disturbed offenders. Where protective services, drug and alcohol services and others work alongside mental health services, both interagency and interdisciplinary communication require attention. Poor communication, limited support and supervision for junior members of staff, and a failure to remain mindful of past history are matters that are repeatedly raised in inquiries following adverse events. Prins also suggests that as clinicians we may be less than willing to recognise our own response to the mentally disturbed offender. ‘Empathic objectivity’ may be a necessary element of working with persons whose actions are abhorrent, but there is a potential risk that what Prins terms ‘ambivalent investment’ may of itself negatively impact on the implementation or effectiveness of interventions directed to lessen risk.
This book deserves a wide readership. In current mental health service delivery there is risk of the development of a gulf between the expectations of the policy makers, management, and those making the front-line decisions. In a way that conveys an understanding of the difficulties of clinical decision-making, Prins exhorts us to think more deeply and critically about issues associated with risk assessment. He does not, of course, answer the question, ‘Will they do it again?’ but does support the provision of a clear rationale for decisions made and the continuing education of the public on the realities of risk assessment in the mentally disturbed.