Tag: risk

Ordinary risks and accepted fictions

Ordinary risksThis new paper you need to read. You also can, because it is published in gold open access form and is therefore free to download to anyone with an internet connection. Lead authored by Michael Coffey, and arising from the larger COCAPP study (see also here, here and here), it draws on qualitative data to examine in detail what staff, service users and carers say about risk assessment and management. Here’s the abstract:

Background

Communication and information sharing are considered crucial to recovery-focused mental health services. Effective mental health care planning and coordination includes assessment and management of risk and safety.

Objective

Using data from our cross-national mixed-method study of care planning and coordination, we examined what patients, family members and workers say about risk assessment and management and explored the contents of care plans.

Design

Thematic analysis of qualitative research interviews (n = 117) with patients, family members and workers, across four English and two Welsh National Health Service sites. Care plans were reviewed (n = 33) using a structured template.

Findings

Participants have contrasting priorities in relation to risk. Patients see benefit in discussions about risk, but cast the process as a worker priority that may lead to loss of liberty. Relationships with workers are key to family members and patients; however, worker claims of involving people in the care planning process do not extend to risk assessment and management procedures for fear of causing upset. Workers locate risk as coming from the person rather than social or environmental factors, are risk averse and appear to prioritize the procedural aspects of assessment.

Conclusions

Despite limitations, risk assessment is treated as legitimate work by professionals. Risk assessment practice operates as a type of fiction in which poor predictive ability and fear of consequences are accepted in the interests of normative certainty by all parties. As a consequence, risk adverse options are encouraged by workers and patients steered away from opportunities for ordinary risks thereby hindering the mobilization of their strengths and abilities.

Reported here is one of the most important sets of findings arising from the COCAPP study. Diana Rose has written a post on the article, which is scheduled to appear on the inestimable Mental Elf site next week. I’m very much looking forward to reading that.

Risk in inpatient child and adolescent mental health services

This week our full report from the RiSC study, An evidence synthesis of risk identification, assessment and management for young people using tier 4 inpatient child and adolescent mental health services, has been published in Health Services and Delivery Research. This is in gold open access form, and is free to download and read.

Here’s our plain English summary:

In our two-part study we brought together evidence in the area of risk for young people admitted to mental health hospital. First, we searched two electronic databases, finding 124 articles. Most were concerned with clinical risks, such as the risks of suicide. Using diagrams we grouped these articles together under a number of themes.

Young people who had been inpatients in mental health hospital, carers, managers and professionals helped us prioritise the types of risk we should concentrate on in the second part of our study. Our top two priorities were the risks of dislocation and contagion. We used the word ‘dislocation’ to refer to the risks of being removed from normal life, of experiencing challenges to identity and of being stigmatised. We used it to refer to the risks to friendships and families, and to education. We used ‘contagion’ to refer to the risks of learning unhelpful behaviour and making unhelpful friendships.

We searched 17 databases and a large number of websites for evidence in these areas. We asked hospital staff to send us information on how they managed these risks and we searched journals and reference lists. We identified 40 items to include in our review and 20 policy and guidance documents. The quality of the studies varied. We grouped the evidence together under seven categories.

We found little evidence to guide practice. The risks of dislocation and contagion are important, but research is needed to inform how staff might identify, assess and manage them.

This has been an excellent project to work on: a great team, and some good engagement with young people and others with a shared interest in what we’ve been up to. Next up is an accessible summary, and some writing of articles. More to follow!