Royal College of Psychiatrists: Rethinking risk to others, new report considers risk posed by mental health service users

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Tuesday, 03, Jun 2008 12:00

Rethinking Risk to Others is the first of a series of reports from the Royal College of Psychiatrists on the risks posed to others by users of mental health services. Subsequent reports will consider other areas of risk, including risk to self, and risk through self-neglect.

This report aims to stimulate further debate and research and, most importantly, improvements in clinical practice, and patient and public safety. It sets out current understanding of best practice in risk assessment and management, and points to future action needed for further improvements.

The assessment and management of risk is integral to psychiatric practice. Over the last 10 years, the risk posed by some mental health service users to others has been brought into the spotlight by the government and the media, as enquiries into serious incidents have suggested failings in the risk management of some mentally disordered patients.

Against this background, and a growing pressure on psychiatrists to predict and minimise risk, the College set up a multidisciplinary ‘scoping group’ to examine and respond to concerns. In addition, a survey was responded to by 2000 College members on their views about current risk assessment strategies adopted by mental health providers.

Key findings of the report include:

· Culture of preoccupation with risk to others has emerged in the UK. Homicide and other enquiries that have suggested failings in risk assessment and management by mental health professionals, appears to have had a negative impact on professional practice, on service users and the public.

· Whilst negative outcomes can be avoided or reduced by sensible contingency planning, risk cannot be eliminated. Accurate prediction is never possible in individual patients.

· Risk assessment is of a current situation, not a predictor of a particular event. It can only stratify people into low, medium or high risk groups, which will help decide appropriate care, treatment and risk management strategy

· Improvements are needed in training and continuing professional development in risk assessment and management

· Cooperation with patients and carers in assessing and managing risk should be fostered through care planning and through the use of ‘crisis cards’ and other evaluated initiatives

· Positive risk management is part of a carefully constructed plan, and is a required competence for all mental health practitioners

· Risk management requires an organisational strategy as well as competent efforts by individual practitioners.

The report recommends that:

· The contribution of substance misuse must be recognised and adequately treated.

· Risk assessment forms should be evidence-based

· The content of discharge letters to GPs should be audited regularly

· A national standard approach to risk assessment is required

· There should be collaboration between the mental health team, patients and carers in as trusting a way as possible. Users’ ‘risk triggers’ should be fully considered

· Quality improvement networks should include risk assessment

· Urgent mental health care in the acute hospital must be commissioned appropriately

· The psychiatric curriculum must include training in risk assessment and management

· Continuing professional development should include regular updates on risk assessment and management

· Organisations involved in the care and treatment of mental health patients should have inter-agency risk management protocols in place for information sharing about potential risks.

CR 150 Rethinking Risk to Others costs £10 and is available from the College Book Sales office on: +44 (0)20 7235 2351 ext 146, at the Royal College of Psychiatrists, 17 Belgrave Square, London, SW1X 8PG, UK.

For further information please contact Deborah Hart or Thomas Kennedy in the Communications and Policy Department.

Telephone: 020 7235 2351 Extensions. 127 or 154

E-mail: dhart@rcpsych.ac.uk or tkennedy@rcpsych.ac.uk.