An Ecological Model for High-Risk Professional Decision-Making in Mental Health: International Perspectives

Abstract

Mental health professionals are frequently presented with situations in which they must assess the risk that a client will cause harm to themselves or others. Troublingly, however, predictions of risk are remarkably inaccurate even when made by those who are highly skilled and highly trained. Consequently, many jurisdictions have moved to impose standardized decision-making tools aimed at improving outcomes. Using a decision-making ecology framework, this conceptual paper presents research on professional decision-making in situations of risk, using qualitative, survey, and experimental designs conducted in three countries. Results reveal that while risk assessment tools focus on client factors that contribute to the risk of harm to self or others, the nature of professional decision-making is far more complex. That is, the manner in which professionals interpret and describe features of the client and their situation, is influenced by the worker’s own personal and professional experiences, and the organizational and societal context in which they are located. Although part of the rationale of standardized approaches is to reduce complexity, our collective work demonstrates that the power of personal and social processes to shape decision-making often overwhelm the intention to simplify and standardize. Implications for policy and practice are discussed.

Workplace violence in the COVID-19 era: a qualitative analysis of harassment and threats against public health professionals in Canada

“…Workplace violence against public health workers was associated with depression, PTSD and suicidal ideation. 17 Factors affecting response to workplace violence Among factors affecting an individual's susceptibility or resilience to distress when exposed to traumatic stressors in the workplace, [18][19][20][21] media and public outrage following a tragic event [22][23][24] have been associated with a sense of isolation and increased levels of traumatic stress among professionals, lower overall public confidence in the system, increased hostility to those working in public services and low morale throughout organisations. 23 25 26 The nature of the organisational environment has also been found to mitigate emotional response to workplace trauma exposure, including factors such as workload, organisational climate, social support, supervision 24 27-30 and perceptions of workplace discrimination and harassment.…”

The mental health detention process: a scoping review to inform GP training

“…Geographical spread was stated as Republic of Ireland ( 5), Northern Ireland (3), Scotland (6), England (22) England & Wales (2), United Kingdom (1), Canada (2), United States (9), Australia (1) and South Africa (1). The range of professional groups involved included medical students (1), GPs (6), psychiatrists (9), emergency medicine doctors (1), unspecified 'doctors' (6), nursing students (1), mental health nurses (3), approved social workers (ASWs) (7), approved mental health professionals (AMHPs) (7) and police (5). Six articles were multidisciplinary.…”

“…Alongside practical issues surrounding necessary paperwork, the clinical decision-making process can be complex and challenging. 4 , 5 There is the additional complexity of coordinating a prompt, interdisciplinary team response, while maintaining the provision of safe clinical practice. 2 , 6 This high-stakes assessment can have a profound, lasting impact on the patient, carers, and all involved.…”