This study was about risk assessment and risk
assessment describes the process where in mental health services people are categorised
as at low, medium or high risk in order to predict what’s going to happen to them. The problem is – that prediction tends to
be not very good. So this study of risk assessment for suicide,
we asked every mental health service in the United Kingdom for copies of the tools, the
instruments, they used to collect information on risk. We also did an online survey of mental health
professionals, of patients (service users) and their carers to see what they thought
about risk assessment tools.
And then we did a more detailed study of mental
health professionals to get their views and suggestions for how risk assessment tools
might be improved. In terms of what we found, we obtained 156
different risk assessment tools from the mental health services across the country, and there
was little consistency. Some risk assessment tools were 1 page, others
were 20 pages. They collected different types of information. About 7 out of 10, about 70%, had been locally
developed (just in the services themselves) and contrary to national guidance many of
them sought to categorise people as at low, medium, or high risk and make predictions
about future behaviour. In terms of the online survey, what staff
told us was that sometimes these tools could be helpful.
They could be helpful to act as prompts, to
measure change, or to help formulate risks – that is to draw different risk factors together
to further their understanding. But there were also potential problems with
them, so they might provide false reassurance, there were also issues around training, and
practical issues; so sometimes the risk assessment tools were very long and took a long time
to fill in. So there were practical impediments to their
use as well. Service users and carers, what they told us
was that they wanted staff who were comfortable asking about suicide risk, comfortable asking
those questions. They wanted assessments that were, weren’t
impersonal, tick box exercises, that really sought to engage them and involve them collaboratively. So that was another important message that
service users themselves, and their carers’, needed to be involved in the risk assessment
process.
