Patient perspectives of helpful risk management practices within mental health services. A mixed studies systematic review of primary research

Abstract

Accessible Summary What is known about the subject? Risk in psychiatry involves harm to self or others owing to mental health difficulties, for example iatrogenic effects of treatment, self‐harm, suicide and violence. Risk management is a framework to minimize risks, comprising of risk assessment, generation of risk management plans and evaluation of interventions. Literature has extensively explored risk management and presented a critique that its practices can lead to patient harm. However, there is a paucity of literature about what patients identify as helpful risk management practices, despite the potential for such patient views to ameliorate harm and improve mental health care. What this paper adds to existing knowledge Interpersonal relationships with clinicians, and communication that keeps patients involved and informed of management processes, were found to be central to beneficial risk management practices, while patients having agency and autonomy to influence their participation was also important. Beneficial interpersonal relationships and connectivity in the form of patients’ wider community of support were found to be influential in aiding risk management. Meaningful relationships, and particularly peer support, that maintained personal and collective identities were prevalent in the literature. What are the implications for practice? Rendering risk management more visible and accessible in practice might cultivate an openness that promotes patient participation. This includes drawing on a wider network of support, for example the patient’s friends and family, as well as having advocacy utilizing peer support. AbstractIntroductionMinimizing the harm that patients pose to themselves and others, due to mental health difficulties, is a central component of risk management in psychiatry. However, risk management itself can cause patient harm, but despite this and the potentially informative value of lived experience, little is known about what patients want or expect from risk management.AimTo review research and explore what patients consider beneficial in risk management practice.MethodA mixed studies systematic review utilizing PRISMA guidelines, alongside a convergent qualitative design to categorize findings.ResultsTwelve papers were identified, generating two categories of beneficial practices: interpersonal relationships and communication with clinicians; coupled with patient agency in their own risk management.DiscussionConnectivity appears important. Particularly patients feeling involved, and their voices being heard in both the identification of risks and then shaping risk management practice. Moreover, this included involvement of friends, family and peers to widen input and supportive networks beyond clinical relationships.Implications for PracticeRisk management needs to be an accessible part of care, which is more inclusive of patient views and needs. The latter might also be aided by drawing on the patient's wider community in order to provide more effective support and r...

Positive risk management: Staff perspectives in acute mental health inpatient settings

“…Deering et al. (2019) systematic review supported the notion of collaboration and relationships within risk management. Their results indicated that service users valued interpersonal relationships, feeling heard, and being part of the process.…”

A systematic review of policy and clinical guidelines on positive risk management

“…Having an awareness of the factors that might influence clinicians' own risk understanding, such as their current knowledge base, beliefs and attitudes, and relationship with service users, was also deemed important. A recent systematic review (Deering et al, 2019) supports the centrality of building relationships for effective risk management and that service users value interpersonal relationships, feeling heard and being included in the process, which may be important for future PRM recommendations.…”

Exploring pornography use in secure hospitals: a qualitative analysis

“…Although, Haines et al (2018) do not mention pornography specifically, it is possible that the same process applies. A recent systematic review by Deering et al (2019) explored what patients felt were beneficial with regards to their risk management. They noted that it was important that patients felt involved in the risk management plan in addition to their wider support network, such a families and friends.…”

“…This, therefore, could improve clinical practice, and allow members of the team to feel valued and important as well as reducing possible biases. Interestingly, none of the participants considered involving the patients in the decision making or risk management process despite research indicating that patients find this beneficial (Deering et al, 2019).…”

“…However, as noted by Mercer (2010), the reviewing of pornographic material is often completed by nursing staff and unfortunately no nursing staff volunteered to be included within this study. It is also recommended that when making decisions regarding access to pornography that the patient is included in this process (Deering et al, 2019). Interestingly none of the participants spoke about the issues that come with the production of pornography material.…”