Involving carers in risk assessment: a study of a structured dialogue between mental health nurses and carers

Jackson, Haley; Wray, Jane; Gardiner, Eric; Flanagan, Tracy

doi:10.1177/1744987119851533

Cited by 7 publications

(3 citation statements)

References 22 publications

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“…Despite the abundance of government policy, quality standards, organisational strategies, and international research supporting carer involvement, audits consistently highlight inadequate and inconsistent levels of carer collaboration and integration within mental healthcare (Dirik et al, 2017;Jackson et al, 2019). It is therefore evident that further steps are needed to address the barriers that prevent the "therapeutic alliance between service user, staff member and carer that promotes safety, supports recovery and sustains wellbeing" (Worthington et al, 2013, p. 3), and to challenge the organisational culture and attitudes that obstruct its implementation.…”

Section: Barriers To Involvementmentioning

confidence: 99%

Stronger Together: A case study exploring the development and piloting of an intervention facilitating family and informal carers to support adults at risk of suicide and serious self-harm

Frances

2024

Preprint

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Globally, more than 700,000 people die by suicide every year. Yet suicide is seen as a preventable phenomenon, and there are calls for prevention to be prioritised by mental health services. In the UK there is growing consensus in policies and guidelines towards carer involvement in a person’s mental healthcare, including their role in suicide prevention, and in the co-design and co-production of services. Notwithstanding, inadequate and inconsistent levels of collaborative working remain commonplace, with confidentiality and information-sharing protocols acting as a major barrier to involvement. There is also little recognition of the distress and difficulties carers may face in supporting those exhibiting suicidal behaviours, and what information, knowledge and support may be needed for them to safely hold high levels of risk.This project report provides a qualitative analysis of the literature exploring the needs and challenges of carers supporting suicidal adults, and how these can be addressed. It then critically reflects on the co-production of Stronger Together, a two-day quality improvement initiative being piloted in Devon to reduce suicide risk and improve patient safety through carer involvement. It also examines how this programme addresses (1) the needs and challenges of carers supporting those at high risk of suicide and serious harm, and (2) the barriers to carer collaboration within mental healthcare. A case study methodology employing autoethnographic and questionnaire methods is used for this purpose. Co-production was fundamental to shaping the content, structure and delivery of Stronger Together, to ensure its relevance and accessibility to carers. Learning from the development and implementation of this programme will be of value to mental health Trusts looking to find ways to embed a culture of carer collaboration to improve patient safety, reduce deaths by suicide and more effectively support patients’ family and friends.

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Section: Barriers To Involvementmentioning

confidence: 99%

Stronger Together: A case study exploring the development and piloting of an intervention facilitating family and informal carers to support adults at risk of suicide and serious self-harm

Frances

2024

Preprint

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“…84 Engaging carers in discussions on risk has been shown to improve carer satisfaction. 98 Davies' structured interview for assessing adolescents in crisis 17 is one tool that includes structured interview/checklist assessment with 'parenters'. The rationale cited is the need to guard against any omissions, for whatever reason, from the young person.…”

Section: Supporting Evidencementioning

confidence: 99%

Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis

Cantrell,

Sworn,

Chambers

et al. 2024

Health Soc Care Deliv Res

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Background Risk assessment is a key process when a child or adolescent presents at risk for self-harm or suicide in a mental health crisis or emergency. Risk assessment by a healthcare professional should be included within a biopsychosocial assessment. However, the predictive value of risk-screening tools for self-harm and suicide in children and adolescents is consistently challenged. A review is needed to explore how best to undertake risk assessment and the appropriate role for tools/checklists within the assessment pathway. Aims To map research relating to risk assessment for child and adolescent mental health and to identify features that relate to a successful risk assessment. Objectives To review factors within the clinical encounter that impact upon risk assessments for self-harm and suicide in children and adolescents: to conduct a realist synthesis to understand mechanisms for risk assessment, why they occur and how they vary by context to conduct a mapping review of primary studies/reviews to describe available tools of applicability to the UK. Data sources Databases, including MEDLINE, PsycINFO®, EMBASE, CINAHL, HMIC, Science and Social Sciences Citation Index and the Cochrane Library, were searched (September 2021). Searches were also conducted for reports from websites. Review methods A resource-constrained realist synthesis was conducted exploring factors that impact upon risk assessments for self-harm and suicide. This was accompanied by a mapping review of primary studies/reviews describing risk-assessment tools and approaches used in UK child and adolescent mental health. Following piloting, four reviewers screened retrieved records. Items were coded for the mapping and/or for inclusion in the realist synthesis. The review team examined the validity and limitations of risk-screening tools. In addition, the team identified structured approaches to risk assessment. Reporting of the realist synthesis followed RAMESES guidelines. Results From 4084 unique citations, 249 papers were reviewed and 41 studies (49 tools) were included in the mapping review. Eight reviews were identified following full-text screening. Fifty-seven papers were identified for the realist review. Findings highlight 14 explanations (programme theories) for a successful risk assessment for self-harm and suicide. Forty-nine individual assessment tools/approaches were identified. Few tools were developed in the UK, specifically for children and adolescents. These lacked formal independent evaluation. No risk-screening tool is suitable for risk prediction; optimal approaches incorporate a relationship of trust, involvement of the family, where appropriate, and a patient-centred holistic approach. The objective of risk assessment should be elicitation of information to direct a risk formulation and care plan. Limitations Many identified tools are well-established but lack scientific validity, particularly predictive validity, or clinical utility. Programme theories were generated rapidly from a survey of risk assessment. Conclusions No single checklist/approach meets the needs of risk assessment for self-harm and suicide. A whole-system approach is required, informed by structured clinical judgement. Useful components include a holistic assessment within a climate of trust, facilitated by family involvement. Study registration This study is registered as PROSPERO CRD42021276671. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135079) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.

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“…Notwithstanding, audits continue to highlight poor levels of carer collaboration and integration within mental healthcare. 13,14 In response to the theme of poor family involvement consistently identified in inquest reports into deaths by suicide in Devon, UK, 15 Devon Partnership Trust's (https://www.dpt.nhs.uk/) (DPT) Safe From Suicide team was tasked with developing a quality improvement intervention that addressed this problem. This brief report discusses the co-production of Stronger Together (ST), a training initiative which aims to improve patient safety and reduce deaths by suicide through carer involvement and collaboration which was piloted from January-July 2023 and externally evaluated by University of Exeter.…”

Section: Introductionmentioning

confidence: 99%

co-production of an intervention facilitating informal caregivers to support adults at risk of suicide and serious self-harm: a brief report

Frances

2024

J Rec Mental Health

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The recovery model in mental healthcare increasingly recognises suicidal behaviour as an interpersonal issue, with caregivers seen as essential in prevention. In the UK, as in other parts of the world, there is growing consensus in policies, guidelines and academic research towards carer involvement in a person’s mental healthcare, yet inconsistency in practice remain commonplace. In response to the theme of poor family involvement consistently identified in reports into deaths by suicide in Devon (UK), Devon Partnership NHS Trust has developed Stronger Together, a training programme for carers of suicidal adults. The programme, co-produced with carers and service users, also includes a collaborative learning component with healthcare staff. This report explores the programme's co-production and my personal involvement. Co-production shaped Stronger Together, aligning it with national policy and research findings. Its co-delivery and co-learning approach uniquely addresses carers' needs and fosters staff-carer collaboration. Learning from this initiative could help other mental health trusts foster a culture of carer collaboration, potentially improving patient safety, reducing caregiver burden and enhancing support for patients and families to reduce deaths by suicide. It also strengthens the case for co-production of training that effectively meets the needs of participants and delivers on its outcomes.

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Involving carers in risk assessment: a study of a structured dialogue between mental health nurses and carers

Cited by 7 publications

References 22 publications

Stronger Together: A case study exploring the development and piloting of an intervention facilitating family and informal carers to support adults at risk of suicide and serious self-harm

Stronger Together: A case study exploring the development and piloting of an intervention facilitating family and informal carers to support adults at risk of suicide and serious self-harm

Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis

co-production of an intervention facilitating informal caregivers to support adults at risk of suicide and serious self-harm: a brief report

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