Surveying clinician perceptions of risk assessment and management practices in mental health service provision

Abstract

The confidence that clinicians placed in risk assessment and management practices (despite an absence of evidence) is disconcerting. Given the dominance of risk assessment and management, health services mandating such practices have a duty to inform employees of the current evidence base for this approach in reducing risk.

Perception of risk for older people living with a mental illness: Balancing uncertainty

“…Risk assessment and management practices are now so prevalent in mental health discourse that they are seen to have taken precedence over many other clinical practices (Savy & Sawyer ; Szmukler ; Wand et al ). Indeed, concerns over reputational risk to institutions are now thought by some to surpass the interests of consumers (Brown & Calnan ) and have assumed noticeable salience.…”

“…Risk has been challenged as being oriented towards risk avoidance and the physical safety of staff to the detriment of therapeutic outcomes for consumers (Barker & Buchanan‐Barker ; Manuel & Crowe ; Wand ; Wand et al ). This approach to risk is considered an embroilment of medical and legal procedures, which are now inevitably intertwined and which have been strongly influenced by the obsession to ‘calculate’ risk in order to avoid it (Barker & Buchanan‐Barker ).…”

Considering the culture of blame in mental health care and service delivery

“…In the aforementioned survey, 72% of respondents agreed with the statement I often reflect on the potential medico-legal ramifications for me with the decisions I make about an individual's level of risk, and 87% of respondents agreed There is organizational pressure around the assessment and management of risk (Wand et al 2015). Mental health clinicians are consequently instilled with a fear of legal reprisal and appearing before the Coroner.…”

“…In a survey of mental health clinicians (n = 164) on their perceptions of assessing and managing risk, 72% of respondents agreed that A culture of blame exists around the assessment and management of risk in mental health services. Additionally, 71% of respondents agreed that Following an adverse event mental health staff are left feeling responsible for inaccurate assessment and management of risk (Wand et al 2015).…”

“…Mental health clinicians are consequently instilled with a fear of legal reprisal and appearing before the Coroner. In the aforementioned survey, 72% of respondents agreed with the statement I often reflect on the potential medico-legal ramifications for me with the decisions I make about an individual's level of risk, and 87% of respondents agreed There is organizational pressure around the assessment and management of risk (Wand et al 2015). This fear is not unfounded, but would be assisted by efforts on behalf of mental health services to inform the Coroner's office and other relevant agencies and organizations of the significant limitations associated with circumventing, let alone predicting adverse events.…”