WARRN – a formulation-based risk assessment process: its implementation and impact across a whole country

Abstract

Purpose Wales Applied Risk Research Network (WARRN) is a formulation-based technique for the assessment and management of serious risk (e.g. violence to others, suicide, etc.) for users of mental health services. It has been gradually adopted as the risk evaluation and safety-planning technique for all seven health boards in Wales. The purpose of this paper is to examine the opinions of WARRN as used within these health boards. Design/methodology/approach An online survey was disseminated to NHS clinicians in secondary mental health services to evaluate their perceptions of the use and effectiveness of WARRN. Data from 486 clinicians were analysed with both quantitative and qualitative methods. Findings Results indicated that the overall impact of WARRN on secondary mental health care was very positive, with clinicians reporting increased skills in the domains of clinical risk formulation, safety-planning and communication, as well as increased confidence in their skills and abilities in these areas. Clinicians also reported that the “common-language” created by having all NHS health boards in Wales using the same risk assessment process facilitated the communication of safety-planning. Crucially, NHS staff believed that the safety of service users and of the general public had increased due to the adoption of WARRN in their health board and many believed that lives had been saved as a result. Originality/value WARRN is perceived to have improved clinical skills in risk assessment and safety-planning across Wales and saved lives.

Managing suicidality in inpatient care: a rapid review

“…It is important to ensure that observing staff understand the particular patient’s risk formulation, care plan and observational requirements as well as the service’s policy and procedures, for example, how to respond when absconding has occurred. The increased confidence that nurses have when using the WARNN formulation is noted (Gray et al , 2019; Snowden et al , 2019) but no evidence was located in this review that correlates reduced suicide in hospital and WARNN. Most suicide attempts occurred in the evening or night hours and peaking during time of nursing shift handovers when supervision is at a reduced level. Strategies to manage these high-risk periods need to be considered.…”

“…It is important to ensure that observing staff understand the particular patient's risk formulation, care plan and observational requirements as well as the service's policy and procedures, for example, how to respond when absconding has occurred. The increased confidence that nurses have when using the WARNN formulation is noted (Gray et al, 2019;Snowden et al, 2019) but no evidence was located in this review that correlates reduced suicide in hospital and WARNN.…”

“…Evidence suggests that implementing guideline recommendations, training and environmental changes related to ward safety have the potential to reduce suicide-related mortality (Cardell et al , 2009; De Santis et al , 2015; Kapur et al , 2016; Mokkenstorm et al , 2018; Navin et al , 2019). A number of organisational approaches have been described such as the Tidal Model (Barker and Buchanan-Baker, 2005) and the implementation of Wales Applied Risk Research Network (WARRN) (Gray et al , 2019; Snowden et al , 2019). In an evaluation of the Tidal Model within acute care settings (Barker and Buchanan-Baker, 2010), there were reductions in the number of self-harm and suicide attempts, reductions in aggressive verbal and physical events towards staff and fewer incidents needing physical control and restraint procedures.…”

“…violence to others, suicide, etc.) for users of mental health services (Gray et al , 2019; Snowden et al , 2019). An online survey was disseminated to NHS clinicians used to assess the effectiveness of WARRN within secondary mental health services (Snowden et al , 2019) and child and adolescent mental health services (Gray et al , 2019).…”

“…for users of mental health services (Gray et al , 2019; Snowden et al , 2019). An online survey was disseminated to NHS clinicians used to assess the effectiveness of WARRN within secondary mental health services (Snowden et al , 2019) and child and adolescent mental health services (Gray et al , 2019). The clinicians perceived WARRN to have improved their clinical skill set and their confidence in conducting risk evaluations and safety planning, increased patient safety and the safety of the general public strongly and a belief that WARRN had saved lives (Gray et al , 2019; Snowden et al , 2019).…”