Risk Management In Mental Health Services Page 28
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54Identification of risk is concerned with accumulating information about the
individual, being mindful of the need for multiple assessment methods and
the use of different sources of information, for example, obtaining
collateral information from family members, friends, General Practitioner
and other agencies as appropriate.
Identification of risk also involves identifying historical and current risk
factors relating to the outcome of concern (e.g. self harm) and this is
where evidence-based tools and guidelines can be utilised. These usually
involve the synthesising of the information into a variety of profiles of
mental illnesses, adverse social circumstances, and life events etc. The use
of evidence based tools and guidelines can facilitate a structured
organisational approach to risk assessment.
The reality of clinical practice is that risk tests and/or scales can help
inform clinical judgement but not replace it, as ultimately it is people, not
tests who should make decisions (see tools below in Table 3.1).
Risk is safely identified if all parameters of individual functioning are
examined. Research has shown that the four essential parameters of risk
are:
History
Clinical
Disposition
Context
Case information (history, mental state, substance misuse etc.) and the
presence of risk factors (historical, current, and contextual) are considered
here (O’Rourke, 2003; Doyle and Dolan, 2007).
Risk management therefore emphasises the need to assess the historical
and current presentation, the clinically relevant behaviours, the personality
features (both strengths and deficits) and the contextual factors, again
both strengths and protective factors and also any issues which may
increase risk. Risk assessment should be dynamic not static and should be
seen as a continuous process which is mediated by changing conditions.
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