Risk assessment and management approaches on mental health units

Abstract

This exploratory and descriptive study took place in one Canadian province. The study aimed to: (1) to identify and describe the nature and extent of current risk assessment and management approaches used in the adult inpatient mental health and forensic units; and (2) to identify good practice and shortfalls in the nature and extent of the approaches currently utilized. Data were collected from 48 participants through nine focus groups. Participants reported that they used a clinical approach to risk assessment. They had also not considered risk assessment and management as a proactive structured process. Education and training was also limited and skills were developed over time through practice. Five keys issues are discussed as important: reliance on clinical judgement alone is not the best choice to make; the need to consider risk as a whole concept; risk management being more reactive than proactive; education and training; and client involvement in risk assessment.

There is more to risk and safety planning than dramatic risks: Mental health nurses’ risk assessment and safety‐management practice

“…In terms of assessment practices, studies describe nurses' reliance on informal unstructured processes, intuition, and 'gut feelings' to guide their assessment. In addition, ineffective safety-planning practices were also found, with studies highlighting the dissociation between riskassessment and safety-management plans (Gilbert et al 2011;Langan & Lindow 2004;Woods 2013). While some of the community mental health nurses (n = 20) in Godin's study reported using tools, they still favoured clinical judgment and 'interpretative' approaches, and relied heavily on their own 'instinct' to guide assessment.…”

“…One study was located that reported nurses using validated tools or derivatives to guide their practice (Godin 2004). In particular, little evidence of proactive safety planning and therapeutic risk taking was located, with a focus instead on crisis intervention (Delaney et al 2001;Muir-Cochrane et al 2011;Murphy 2004;Raven & Rix 1999;Trenoweth 2003;Woods 2013). In addition, ineffective safety-planning practices were also found, with studies highlighting the dissociation between riskassessment and safety-management plans (Gilbert et al 2011;Langan & Lindow 2004;Woods 2013).…”

“…While some of the community mental health nurses (n = 20) in Godin's study reported using tools, they still favoured clinical judgment and 'interpretative' approaches, and relied heavily on their own 'instinct' to guide assessment. Reports of other disconnections between the riskassessment process and the formulation of a safety plan included some studies reporting that risk-assessment and safety-planning practices were characterized by incomplete and inconsistent assessments, safety plans that were not informed by assessments, inconsistent documentation of risk, and a lack of ongoing review of risk and safety plans (Delaney et al 2001;Gilbert et al 2011;Godin 2004;Woods 2013). In particular, little evidence of proactive safety planning and therapeutic risk taking was located, with a focus instead on crisis intervention (Delaney et al 2001;Muir-Cochrane et al 2011;Murphy 2004;Raven & Rix 1999;Trenoweth 2003;Woods 2013).…”

“…Consequently, emphasis was on 'dangerousness' and 'dramatic risks', which in recent years has been fuelled by high-profile cases of homicide involving people with a history of mental health problems (Muir-Cochrane et al 2011), the growth in literature that perpetuated the idea that all risks can and should be identified and prevented (Higgins et al 2015), and the development of the availability of actuarially-based risk-assessment tools, which attempt to identify individuals' potential for violence or the risk of suicide (Doyle & Dolan 2002;Godin 2004). However, it is acknowledged that screening and prediction are very much an inexact science beset with false positives and negatives (Woods 2013).…”

Measures for screening for intimate partner violence: a systematic review

“…Risk assessment and safety planning is integral to the role of the mental health nurse and screening for the identification of IPV is part of this assessment (Higgins et al . ,b, Woods ). Numerous UK and Irish documents and reports provide guidelines on how to identify and manage risk in the mental health setting [The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, , National Institute for Health and Care Excellence (NICE) , Department of Health 2007; Health Service Executive ].…”