Psychiatric risk assessments

Sir, – I refer to the terrible tragedy that has befallen the Greaney family in Cobh at the hands of Michael Greaney, who stabbed his wife to death, and one of his daughters almost to death, and then took his own life ("Father was cleared to return to Cobh home after psychiatric assessment", December 30th).

Undoubtedly there is a complicated background leading up to this horrific and heart-breaking event, but according to the article Mr Greaney was assessed by a consultant psychiatrist and a multidisciplinary team last October. The outcome of this process was a decision that Mr Greaney posed no risk to his family and recommended that he be allowed back to the family home.

There is a need to acknowledge that psychiatric risk assessment for suicide and violence is of extremely limited value in general psychiatric practice.

This was the conclusion arrived at by one of the world’s foremost experts on risk assessment research, Prof George Szmukler, two years ago.


Prof Szmukler concluded that rare events, such as suicide or serious violence – no matter how tragic they are or how much our society wishes us to prevent them – are impossible to predict with a degree of accuracy that is clinically meaningful.

Society expects psychiatrists to fulfil the role of predicting these risks, but the evidence is very clear – it cannot be done.

There is a need for an open and honest debate about this whole subject to try to find new ways forward to reduce the likelihood of such catastrophes happening again in the future.

My heartfelt condolences to the Greaney family at this dreadful time. – Yours, etc,



Co Cavan.