Risk Assessment: A Reflection on the Principles of Tools to Help Manage Risk of Violence in Mental Health

McCallum, John; Eagle, Kerri

doi:10.1080/13218719.2014.959155

Cited by 6 publications

(2 citation statements)

References 35 publications

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“…Those advocating for their use suggest that they enrich assessment by providing 'an anchor against the force of bias' (Jones & Plowman 2005:135), greater inter-rater reliability and scientific validity, greater transparency around decisions taken as well as providing documentation for review, audit and analysis should a negative event occur (Doyle & Dolan 2002). Critics of the method comment on the little empirical evidence available to support the ability of tools to predict accurately (Crowe & Carlyle 2003, Feeney 2003, Royal College of Psychiatrists 2008, Wand 2012, Boland & Bremner 2013, McCallum & Eagle 2015. Many argue that tools are based on information about groups, which is of limited value in predicting the behaviours of an individual (Kumar & Simpson 2005, Wand 2012).…”

Section: Background Literaturementioning

confidence: 99%

Survey of mental health nurses' attitudes towards risk assessment, risk assessment tools and positive risk

Downes

Gill

Doyle

et al. 2016

Psychiatric Ment Health Nurs

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Introduction Risk assessment and safety planning are considered core components of the role of the mental health nurse; however, little is known about nurses' attitudes towards risk assessment, use of tools to assess risk or therapeutic risk taking. Aim This study aimed to explore mental health nurses' attitudes towards completing risk assessments, use of tools as an aid, and therapeutic or positive risk. Method An anonymous survey which included 13 attitudinal statements, rated on a five-point Likert scale, was completed by 381 mental health nurses working in adult services in Ireland. Findings Findings indicate strong support for the practice of risk assessment in mental health practice. The vast majority of nurses believe that risk assessment tools facilitate professional decision making; however, there is concern that the use of these tools may negatively impact upon therapeutic engagement with service users. The majority of participants have positive attitudes towards therapeutic risk, believing that service users have the right to take informed risks in the context of recovery-orientated care. Discussion The provision of education on the use of risk assessment tools within the context of engagement may help minimize views that the use of assessment tools are incompatible with therapeutic engagement.

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Section: Background Literaturementioning

confidence: 99%

Survey of mental health nurses' attitudes towards risk assessment, risk assessment tools and positive risk

Downes

Gill

Doyle

et al. 2016

Psychiatric Ment Health Nurs

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“…Critics of actuarial approaches comment on the paucity of empirical evidence to support the ability of tools to predict accurately. 16,[44][45][46] See Programme Theory 12. Many argue that tools are based on information about groups, which is of limited value in predicting the behaviours of an individual.…”

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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History of Forensic Psychology

Helfgott

Wallenborn

2022

Clinical Forensic Psychology

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Risk Assessment: A Reflection on the Principles of Tools to Help Manage Risk of Violence in Mental Health

Cited by 6 publications

References 35 publications

Survey of mental health nurses' attitudes towards risk assessment, risk assessment tools and positive risk

Survey of mental health nurses' attitudes towards risk assessment, risk assessment tools and positive risk

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

History of Forensic Psychology

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