Tools for the job: why relying on risk assessment tools is still a risky business


  • L. WEBB BSc (Hons) MSc PhD

    Corresponding author
    1. Senior Lecturer, Department of Nursing, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
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L. Webb, Department of Nursing, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Elizabeth Gaskell Campus, Hathersage Road, Manchester M13 0JA, UK, E-mail:


Accessible summary

  • • This paper examines the use of assessment tools and other decision-making guidelines in mental health and substance misuse and suggests that clinicians need to understand how the tools were designed in order to judge whether the tool is relevant to the individual client.
  • • It is argued that people with enduring mental health or substance misuse needs present with complex needs which cannot easily be measured by questionnaires or checklists which are often based on simple and straightforward populations of patients.
  • • The importance of this paper is that it highlights the need for clinicians to understand the tools they use rather than rely blindly on the support given to such tools by evidence-based practice research findings.


This theoretical review paper examines the applicability of assessment tools, guidelines and protocols in mental health and substance use care on the basis of the construction of such tools and their reliance on aggregate and actuarial methodologies. Evidence-based practice leads clinicians to increasing reliance on tools for assessment of health status, risk and prediction for a range of clinical needs for individual clients. In the longer-term management of people with enduring and chronic mental health and substance misuse problems, clinicians are often dealing with complex and unstable health needs. The tools available, however, are developed on the basis of majority population evidence and on presumptions of similarity and stability over time. This paper provides explanation of the basis for the development of such tools and argues that clinicians need to be able to evaluate the applicability of tools used for their clients and not just evaluate the internal validity of the tools used to make individual and contextual decisions about individual clients.