Structure and content of risk assessment proformas in mental healthcare

Hawley, Christopher J.; Littlechild, Brian; Sivakumaran, T.; Sender, Helen; Gale, Tim M.; Wilson, Kerry‐Jayne

doi:10.1080/09638230600801462

Cited by 35 publications

(39 citation statements)

References 13 publications

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“…Risk assessment tools consisting of brief checklists of key risk factors, symptoms or antecedents are often regarded as core components of psychosocial assessments, but evidence for their effectiveness is limited 9 13 14. Some guidelines advise against the use of these tools to determine clinical management 9.…”

Section: Introductionmentioning

confidence: 99%

Scales for predicting risk following self-harm: an observational study in 32 hospitals in England

et al. 2014

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ObjectiveTo investigate the extent to which risk scales were used for the assessment of self-harm by emergency department clinicians and mental health staff, and to examine the association between the use of a risk scale and measures of service quality and repeat self-harm within 6 months.DesignObservational study.SettingA stratified random sample of 32 hospitals in England.Participants6442 individuals presenting with self-harm to 32 hospital services during a 3-month period between 2010 and 2011.Outcomes21-item measure of service quality, repeat self-harm within 6 months.ResultsA variety of different risk assessment tools were in use. Unvalidated locally developed proformas were the most commonly used instruments (reported in n=22 (68.8%) mental health services). Risk assessment scales were used in one-third of services, with the SAD PERSONS being the single most commonly used scale. There were no differences in service quality score between hospitals which did and did not use scales as a component of risk assessment (median service quality score (IQR): 14.5 (12.8, 16.4) vs 14.5 (11.4, 16.0), U=121.0, p=0.90), but hospitals which used scales had a lower median rate of repeat self-harm within 6 months (median repeat rate (IQR): 18.5% vs 22.7%, p=0.008, IRR (95% CI) 1.18 (1.00 to 1.37). When adjusted for differences in casemix, this association was attenuated (IRR=1.13, 95% CI (0.98 to 1.3)).ConclusionsThere is little consensus over the best instruments for risk assessment following self-harm. Further research to evaluate the impact of scales following an episode of self-harm is warranted using prospective designs. Until then, it is likely that the indiscriminant use of risk scales in clinical services will continue.

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Section: Introductionmentioning

confidence: 99%

Scales for predicting risk following self-harm: an observational study in 32 hospitals in England

et al. 2014

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“…Risk assessment then can become a form of insurance for professionals who are encouraged to make decisions 'from the perspective of the need to justify it in some public tribunal in the future' (Rose, 1998: 186). This may in part explain why pro-formas used by services tend to focus on risks professionals may be held accountable for at the expense of other risks (Hawley et al, 2006).…”

Section: Marginalised Risksmentioning

confidence: 99%

Risk assessment practice within primary mental health care: A logics perspective

2018

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From the 1980s onwards discourses of risk have continued to grow, almost in ubiquity. Ideas and practices of risk and risk aversion have extended to UK mental health care where services are expected to assess and manage risks, and high quality clinical assessment has been revised to incorporate risk assessment. This article problematises practices of risk assessment in mental health provision, focusing on the base rate problem. It presents an analysis of audio recordings of risk assessments completed within a primary care mental health service. The analysis is informed by a critical logics approach which, using ideas from discourse theory as well as Lacanian psychoanalysis, involves developing a set of logics to describe, analyse and explain social phenomena. We characterise the assessments as functioning according to social logics of well-oiled administration and preservation, whereby bureaucratic processes are prioritised, contingency ironed out or ignored and a need to manage potential risks to the service are the dominant operational frames. These logics are considered in terms of their beatific and horrific fantasmatic dimensions, whereby risk assessment is enacted as infallible (beatific) until clients become threats (horrific), creating a range of potential false negatives, false positives and so forth. These processes function to obscure or background problems with risk assessment, by generating practices that favour and offer protection to assessors, at the expense of those being assessed, thus presenting a challenge to the stated aim of risk assessment practice.

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“…Since the study took place, all of these areas have become foci for government action or targets (ODPM, 2004;DoH, 2005;NIMHE, 2005). However, recent research (Hawley et al, 2006) demonstrates little change to the subject content of risk assessment.…”

Section: Resultsmentioning

confidence: 98%

“…However, these are the exception rather than the rule. Research or development projects on risk assessment (Green et al, 2004;Hawley et al, 2006;Higgins et al, 2005;Macpherson et al, 2002) continue to omit discussion of what, if any role service users should have.…”

Section: Introductionmentioning

confidence: 97%

Involving mental health service users considered to pose a risk to other people in risk assessment

Langan

2008

Journal of Mental Health

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Background: Little research or policy guidance about the involvement of mental health service users in risk assessment exists. Aims: To explore how mental health professionals assessed risk to others and the extent to which they involved service users. To ascertain service users' knowledge of, and involvement in, risk assessment. Method: Qualitative research methodology was used and semi-structured interviews were conducted with mental health services users and professionals. Results: Four key themes arose (i) some professionals lacked confidence or experience in discussing risk openly with service users, (ii) most were not involving service users in risk assessments, (iii) the majority of service users were unaware that professionals were undertaking risk assessments on them, and (iv) there were differing levels of agreement between professionals and service users about risk and its seriousness. Conclusion: There is a research and practice gap about effective means of engaging service users in risk assessment.

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Structure and content of risk assessment proformas in mental healthcare

Cited by 35 publications

References 13 publications

Scales for predicting risk following self-harm: an observational study in 32 hospitals in England

Scales for predicting risk following self-harm: an observational study in 32 hospitals in England

Risk assessment practice within primary mental health care: A logics perspective

Involving mental health service users considered to pose a risk to other people in risk assessment

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