November 20, 1998

The ability of psychiatrists to predict which patients are likely to commit acts of violence has for many years remained a topic of controversy and disagreement among psychiatrists.

In March 1983, following the attempt by former psychiatric patient John Hinckley Jr. to assassinate President Ronald Reagan, APA issued a statement emphasizing its long-held view that "psychiatrists have no special knowledge or ability with which to predict dangerous behavior."

The statement was issued in large part to respond to legal charges that had been filed against Hinckley's psychiatrist and to emphasize APA's position that psychiatrists should not be held legally responsible when a patient or former patient commits an act of violence.

The 1983 statement was not an "official position" statement, which requires a formal vote of adoption by the Board of Trustees. Since that time considerable additional research has been conducted on patient violence, and there is a significant body of evidence suggesting that in the face of certain symptoms, diagnoses, and related conditions, psychiatrists can achieve some degree of success in assessing which patients are at risk of becoming violent.

The absence of an official position on this issue may be remedied next spring when the APA Task Force on Psychiatric Aspects of Violence hopes to have a position statement on this topic ready for review by appropriate APA components, according to task force chair Paul J. Fink, M.D.

Fink said that the position statement will be one in a series of about 10 documents on mental illness and violence that the task force is developing. Other documents in the series will describe various aspects of the complex problem, outline clinical practices that are successful in dealing with potentially violent patients, and provide references that clinicians and researchers can use to enhance their knowledge on the relationship between mental illness and violence. The task force is also contemplating the preparation of teaching tools such as videotapes on topics such as clinician safety, Fink said.