Objectives This article provides an overview of the approaches and instruments used to assess the risk of other-directed violence, with particular focus on risk formulation. Issues pertaining to the development and implementation of these instruments are briefly reviewed. Method A critical analysis of the literature pertaining to the methods and current issues related to risk assessment of other-directed violence is proposed. Results Violence risk assessment instruments are used to manage offenders struggling with mental health issues. They help inform decisions regarding monitoring, supervision, treatment and sentencing in correctional and forensic mental health settings. There are different approaches to violence risk assessment and numerous instruments offered to professionals working in these settings. Considering the structured professional judgement (SPJ) tools, they have considerably evolved in the last years with regard to the types of violence and the methods used to assess and manage risk. Examples of these innovations include taking into consideration victim safety planning and strategies to facilitate risk communication such as scenario planning based on an explanatory framework informed by risk formulation. Risk formulation is a relatively new step in the administration SPJ tools, and invites users to go beyond documenting the presence and relevance of specific risk factors by allowing them to consider the nature and the etiology of violence in an individualized manner. Risk formulation integrates both relevant risk and protective factors that facilitate the process of scenario planning and the identification of successful risk management strategies. Conclusion Although structured approaches to violence risk assessment of offenders struggling with mental health issues have become more and more frequent in many settings, some methodological and implementation issues still have to be tackled. In spite that these issues warrant further discussion based on new empirical data, their contribution to risk reduction and to the success of social rehabilitation of the individuals at the centre of these assessments is undeniable.