This is a book for all clinicians managing psychiatric patients with a history of violence and is not limited to staff in forensic services.

The strength of the book is its accessible style and prose. Maden makes the case for structured clinical risk assessments. In support of this he includes good reviews on the development of risk instruments, the relationship between violence and mental disorder, and psychiatric homicide inquiries. He identifies the latter as a rich source of case histories and presents a series of homicides that illustrate how an enhanced approach to risk assessment might have prevented tragedy. However, we are left with the question of how to control for hindsight bias. Maden does not give enough information about how he selected the cases and although the retrospective HCR–20 score at the start of each example is intriguing, this is not a standard use of the HCR–20 assessment.

I found less convincing Maden's argument that muddled liberal thinking is to blame for poor risk assessment and management. He argues that proper risk management will reduce homicides in the mentally disordered population; however, even with the highest standards of risk assessments and management the number of deaths prevented is likely to be small. He blames RD Laing as the lead culprit for attitude problems in contemporary psychiatry and dismisses the concept of using capacity as a determinant of non-consensual psychiatric treatment.

Overall, the case for structured clinical risk assessments is overwhelming. This book will greatly assist both trainees and experienced psychiatrists in thinking about this topic. I agree with Maden that the killing of Jonathan Zito by Christopher Clunis was a pivotal point in British psychiatry but caution that we should be realistic about the place of mental health services in reducing the level of serious violence in the population.