Risk Assessment and Risk Management: Developing a Model of Shared Learning in Clinical Practice

By Deuter, Kate; Galley, Philip et al. | Advances in Mental Health, February 1, 2013 | Go to article overview

Risk Assessment and Risk Management: Developing a Model of Shared Learning in Clinical Practice


Deuter, Kate, Galley, Philip, Champion, Andrew, Gordon, Andrea, Halczuk, Tony, Jackson, Adrian, Jones, Annette, Legg, Lesley, Murison, Julie, Newman, Conrad, Procter, Nicholas, Williamson, Penny, Advances in Mental Health


Despite extensive research conducted to date, risk remains a poorly defined and understood concept in mental health (Pfohl, 1978; Rose, 1998; Woods, 2012). Within mental health practice, risk has been associated with the notion of 'dangerousness' (Crichton, 2001) and is applied across multiple contexts such as suicide, aggression and violence (Woods, 2012). One of the prime requirements of mental health services, particularly in recent years has been the assessment and safe management of risk behaviours such as self-harm, substance abuse and violent behaviour (Lamont & Brunero, 2009). Generally there appears to be agreement that consumers' risk behaviours should be assessed and managed as clinically indicated (Coffey, 2009). Risk assessment methodology is an expanding contemporary area of practice with a focus on concepts of validity and reliability (Kettles, 2004). Such concepts whilst important do not however sit alone in the risk assessment and management sphere. Other, perhaps less publicised issues such as the health risks faced by mental health consumers resulting from metabolic syndrome and polypharmacy are critical considerations for clinicians. So too, how people's lives are affected by receiving mental health treatment is also pivotal to the way clinicians think about their approach to risk and care delivery.

A shifttowards community mental health care presents new challenges in the assessment and management of ongoing risk behaviours of people who may be seen as 'unpredictable' and 'dangerous' to themselves and others (Coffey, 2009; Lamont & Brunero, 2009). Concurrently, suicide has emerged as a particularly significant aspect of risk assessment and management. Approaches to risk assessment appear to be divided between what is seen as heuristic and unstructured clinical judgement, versus a structured clinical judgement approach. A major problem that remains for clinicians is the dichotomous view taken of risk assessment and risk management, where many clinicians appear to view the completion of a risk assessment as a complete process, as opposed to its part within a dynamic formulation approach to managing risk. The Royal College of Psychiatrists (2008) suggest that in clinical practice the relationship between risk assessment and risk management is limited and that the translation from assessment to a formalised plan is lacking. They further suggest that there is a burgeoning culture of 'file and forget' in risk assessment and risk management which would suggest that the benefits to the consumer are not evident. This may be in part due to governance that an assessment is completed, but little governance of what happens following this. Throughout the risk management process clinicians need to move dynamically and collaboratively from assessment to formulation of assessment, to management interventions and monitoring, potentially returning to assessment to form fresh judgement, to make new formulations and interventions dependent on the variables that are presented to the clinical scenario; all of which may affect the risk potential. As new dynamic variables materialise, the course of the risk management process can alter. A practice of continuous, collaborative review and monitoring is essential to the risk management process. Risk management plans are often documented in clinical files, to be quickly superseded by new information that arrives through various sources. This often requires changes to the plan, a source of tension for clinicians with competing demands, leaving them understandably vulnerable to criticism when things go wrong. In an attempt to further investigate and address these issues, the Shared Learning in Clinical Practice Team was formed, and a Risk Assessment and Risk Management Symposium was planned and conducted.

FORMULATION OF THE GROUP AND SYMPOSIUM

Collaboration was formed between members of the University of South Australia's (UniSA) Mental Health and Substance Abuse Research Group, and the South Australian Department of Health's Acute Unit Matters. …

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