Reading about the assessment and management of risk began, in earnest, for me in 1993. Previously, I had assumed that good training in the management of suicidal patients, reasonable clinical skills, a high-quality community team and the rarely utilised option of referring worrying patients to the forensic psychiatrists together represented an adequate basis for practice in an inner-city catchment area. This naïve assumption was challenged by the popular and political reaction to the actions of Christopher Clunis and Ben Silcock in December 1992, both people with a schizophrenic illness known to services whose dangerous behaviour put them on the front page of newspapers in the UK. A groundbreaking textbook demonstrates that other medical specialities have, partly because of the threat of litigation, been more effective in analysing sources of risk and developing strategies to manage risk (Vincent, 1995). Improving quality is a central plank of the latest National Health Service reform (Department of Health, 1998). There is no doubt that the political driver for this is “the dark side of quality” (Vincent, 1997), how to deal with perceived or actual performance failures in health care such as the seminal ‘Bristol case’, in which cardiothoracic surgeons with an unusually high mortality rate in carrying out a complex procedure were found guilty of serious professional misconduct (Smith, 1998).