Risk Management In Mental Health Services Page 41
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54Components
Examples
History
Poverty Homelessness
Poor/lack of family support
Experience of bullying, harassment or stigmatisation
Clinical
Non-compliance with medication
Decline in hygiene, grooming
Increase in use of alcohol and/or use of illicit drugs
Evidence of more intense symptoms or ominous signs
Demand/avoidance of services
Disposition
Cognitive, Emotional or Behavioural Skills Deficits.
Behaviour indicating major mood changing
for example -
- over spending, elation
- will making, funeral arrangement, depression
Context/
Has the person experienced any of the following:
Environment
- change in living circumstances
- loss of job, relationship
- bereavement
As with suicide and violence and aggression prevention it is easier to
judge the relative importance of the above signs if the mental health
team/professional already know the patient. Although risk cannot be
eliminated, it can be minimised by implementing good clinical practice
inclusive of risk assessment and management which takes cognisance of
vulnerability factors and addresses the incidence of mental instability.
4.3.2
Suicide and Self-harm Prevention
According to the National Parasuicide Register, over 11,000 cases of
deliberate self-harm, some of which are the result of serious suicide
attempts, present to Irish hospitals each year for assessment
and treatment. A history of one or more acts of deliberate self harm is the
strongest predictor of repeated suicidal behaviour, both fatal and non fatal
40
(HSE, DoH&C, 2005).
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