Abstract
Congratulations to Ryan et al. for their excellent paper, “Clinical decisions in psychiatry should not be based on risk assessment”. 1 Risk assessment is a feature of ‘managerialism’, the belief that organizations have more similarities than differences, and running a hospital is exactly the same as running an automobile factory – it's all about management skills. At one time, burned out doctors ran hospitals and health departments, but they gave way to ‘content-free’ (generic) managers. It was just a matter of time until these operatives got involved in clinical practice, and psychiatry was a natural place to start. We wait with interest to see if Ryan and his ilk will reclaim lost territory, or whether psychiatry will become just another branch of institutional HR departments.