Forensic mental health nurses should utilize empirically guided approaches to risk, relying not only on actuarial measures and structured clinical approaches but also on their own qualitative clinical assessments. It is important for forensic mental health nurses to be up-to-date on what the literature is showing regarding risk assessment and prediction. Much of the clinical and research literatures on risk prediction focus on the merits of clinical versus actuarial methods. Although clinical assessments of risk demonstrate better-than-chance accuracy, clinicians have tended to be overly conservative in their predictions of future violence and recidivism; actuarial risk assessments have statistically superior accuracy, are insensitive to change, and do not reflect treatment progress. Decisions in systems involved with risk management must consider the distinctions among three aspects of risk: likelihood/probability, imminence, and severity of outcome. Individuals who score high in these areas should be treated intensively while incarcerated and monitored closely after release. Followup should involve case management services, housing, social support, employment, and ongoing treatment. Whether a system focuses on risk prediction or risk management has critical implications for the kinds of risk factors that are considered and the kinds of activities the system will focus on. Understanding the many demographic, clinical, and situational variables, which have or have not been found to be associated with the various aspects of patient risk, can be used by forensic mental health nurses to inform their practice. References