Probability and loss: two sides of the risk assessment coin

Matthew M. Large*, Olav B. Nielssen

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

16 Citations (Scopus)


Risk assessment has been widely adopted in mental health settings in the hope of preventing harms such as violence to others and suicide. However, risk assessment in its current form is mainly concerned with the probability of adverse events, and does not address the other component of risk- the extent of the resulting loss. Although assessments of the probability of future harm based on actuarial instruments are generally more accurate than the categorisations made by clinicians, actuarial instruments are of little assistance in clinical decision-making because there is no instrument that can estimate the probability of all the harms associated with mental illness, or estimate the extent of the resulting losses. The inability of instruments to distinguish between the risk of common but less serious harms and comparatively rare catastrophic events is a particular limitation of the value of risk categorisations.We should admit that our ability to assess risk is severely limited, and make clinical decisions in a similar way to those in other areas of medicine - by informed consideration of the potential consequences of treatment and nontreatment.

Original languageEnglish
Pages (from-to)413-418
Number of pages6
Issue number11
Publication statusPublished - Nov 2011
Externally publishedYes


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