ImROC call for recovery oriented risk assessment in mental health

policy digest

17 / 06 / 2014

Risk, Safety and Recovery

Implementing Recovery through Organisational Change, June 2014

ImROC has produced a briefing paper which examines the current approaches to risk assessment and management in mental health services, and calls for them to be changed so they are more supportive of individual recovery.

Jed Boardman and Glenn Roberts outline ways of moving towards recovery-orientated risk assessment and safety planning, based on the concept of shared decision making and the joint construction of personal safety plans. They state this approach respects service users’ needs while recognising everyone’s responsibilities – service users, professionals, family, and friends – to behave in a way which upholds personal and public safety.

Perspectives on current risk management and recovery-focused approaches:

Service users

  • Lack of attention is paid to the service users’ views and experience of risk and risk management.
  • There has been little research conducted in this area, contrary to good practice guidelines.
  • Concern that current risk management practice does not focus enough on working with the person to identify what they need and value.
  • Mental health practitioners and services can be risk-avoidant and this can impede rather than support recovery.

Professionals 

  • Managing risk is a central concern in their day-to-day lives.
  • Can fear the consequences of taking risks because of the perceived legal and professional repercussions.
  • A preoccupation with risk and a consequent tendency towards risk-averse practice is stifling creativity and innovation.

Recommendations:

  • The proposed move towards a person-centred, ‘safety planning’ approach to assessing and managing risk needs to be supported nationally by leaders, provider organisations, professional bodies and individual practitioners.
  • It needs to be understood that over-defensive, risk-avoidant practice is bad practice and is associated with avoidable harms to both service users and practitioners.
  • Risk assessment and management based on ‘person-centred safety planning’ is not only more effective but is also more likely to be more acceptable to staff and people using services.
  • Mental health providers and commissioners need to be aware, at a local level, of the criticisms of traditional risk management.
  • The movement to transform traditional risk assessment and management practices into much more collaborative, co-produced, processes must be driven by professionals and service users working together. Both have an equal interest in seeing it develop successfully. This is probably best achieved by having appropriately constituted, local service development groups.
  • Such a group needs to be able to deliver a clear action plan to those with the authority and responsibility for implementation, with specific targets, timelines and accountabilities. Senior managers then need to be committed to implementing it.
  • Implementation is best achieved through the process of agreed goal-setting and review (i.e. P-D-S-A cycles or closed audit loops).
  • Finally, the effectiveness of person-centred safety planning should be a key research and development area for the future. An understanding of the strengths and weaknesses of these approaches needs to be built on to create a relevant evidence base.

The paper recognises that changing the traditional way of doing things is difficult. However it states that mental health services are actually already changing to reflect a much more ‘recovery-orientated’ approach.

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