Risk Assessment in Mental Health

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Questions and Answers

What is defined as the possibility of loss in a clinical setting?

Responsibility

Independence

Assessment

Risk (correct)

Which type of risk factors are static and do not change over time?

Situational risk factors

Environmental risk factors

Dynamic risk factors

Static risk factors (correct)

What is a limitation of risk assessments in psychiatry?

They are always informative.

They only focus on protective factors.

They provide complete certainty.

They can be biased and have blind spots. (correct)

Which approach calculates risk through records and statistics?

Actuarial approaches Signup and view all the answers

How is a standard NHS risk assessment primarily characterized?

Informed process to reduce uncertainty Signup and view all the answers

What is the best predictor of future violence in individuals with mental illness?

Past history of violence Signup and view all the answers

Which factor has been shown to increase the risk of violence in individuals with mental illness?

Combination of substance misuse and non-concordance with medications Signup and view all the answers

Which type of risk involves being a victim rather than a perpetrator of crime in individuals with mental illness?

Risk from others Signup and view all the answers

What socio-demographic factor is considered a major determinant of violence?

Socio-economic status Signup and view all the answers

In terms of risk to health, which situation exemplifies a critical concern for individuals experiencing severe psychotic symptoms?

Not eating due to paranoia Signup and view all the answers

Which of the following statements reflects a common misconception about individuals with mental illness?

They pose a disproportionate risk of violence. Signup and view all the answers

Which scenario best describes environmental risk factors related to violence?

Access to weapons Signup and view all the answers

What role does substance misuse play in the context of violence and mental illness?

It increases the risk of violence significantly. Signup and view all the answers

Which mental disorder has the highest relative risk (RR) for suicide?

Psychosis Signup and view all the answers

Which of the following is considered a static risk factor for suicide?

Age at first diagnosis Signup and view all the answers

What is a common protective factor against suicide?

Strong religious faith Signup and view all the answers

Which group is reported to be three times more likely to die by suicide?

Males Signup and view all the answers

Which of the following factors is NOT a dynamic risk factor for suicide?

Age Signup and view all the answers

What recent experience can significantly increase the risk of suicide?

Previous self-harm or suicide attempt Signup and view all the answers

In a case scenario, a 49-year-old male identifies his children as a protective factor. What else might be a protective factor?

Sense of responsibility Signup and view all the answers

What is one of the key focuses after a serious untoward incident involving suicide risk?

Learning and preventing future harm Signup and view all the answers

What is an example of a risk behavior that can occur outside the home?

Accidental harm due to wandering Signup and view all the answers

What should be monitored to assess physical health risks adequately?

Access to a General Practitioner (GP) Signup and view all the answers

Which of the following indicates a need for safeguarding children?

Presence of a young carer Signup and view all the answers

Which risk behavior is specifically associated with physical health?

Use of IV drugs Signup and view all the answers

What does MARAC stand for in the context of domestic safety?

Multi-agency Risk Assessment Conference Signup and view all the answers

Which of the following is a potential outcome of non-compliance with treatment plans?

Relapsing mental state Signup and view all the answers

What is a sign of financial abuse that can indicate control over an individual?

Locks on doors to prevent leaving Signup and view all the answers

Which behavior is an indicator of risk due to substance misuse?

Sharing needles Signup and view all the answers

What is a primary consideration when assessing risk posed by a partner or family member?

Financial abuse Signup and view all the answers

What factor increases the likelihood of individuals with mental illness becoming victims?

Lifetime prevalence of victimization Signup and view all the answers

Which risk does NOT directly relate to the assessment of harm to others?

Self-neglect Signup and view all the answers

Which of the following is a component of the NHS Psychiatric Risk Assessment Tool related to risk to self?

Harmful eating patterns Signup and view all the answers

Which type of violence is NOT typically included in forms of risk from others?

Coping strategies Signup and view all the answers

What is a sign that could indicate a risk of radicalisation in adult safeguarding?

Weapon possession Signup and view all the answers

What emotional aspect can contribute to the risk from others?

Fear of physical harm Signup and view all the answers

Which of the following is associated with high-risk domestic or sexual abuse assessments?

Bullying or comments Signup and view all the answers

What is a primary characteristic of risk assessments?

They must be individualized to the client's needs. Signup and view all the answers

Which of the following statements is true regarding the function of risk assessments?

They help inform clinical care to mitigate potential risks. Signup and view all the answers

Why must risk assessments be up-to-date?

To reflect the most current understanding of a patient's risk. Signup and view all the answers

What aspect of risk assessments is highlighted as necessary for their effectiveness?

They need to be dynamic and responsive. Signup and view all the answers

Which of the following is NOT essential for a risk assessment?

Being based solely on administrative data. Signup and view all the answers

How should interactions with patients influence risk assessments?

They provide essential information for thorough assessments. Signup and view all the answers

Which phrase best captures the limitations of risk assessments?

They cannot entirely eliminate risks. Signup and view all the answers

What does it mean for a risk assessment to be responsive?

It adjusts according to changes in the patient's condition. Signup and view all the answers

Study Notes

Risk Assessment and Mental Health

The presentation covers risk assessment in clinical settings, including suicide and harm to others.
Aims to highlight various risk presentations, introduce risk assessment/management approaches in psychiatry, and empower professionals regarding risk discussions.
Objectives include defining risk types, listing risk factors (static vs. dynamic), applying a standard NHS risk assessment tool, and discussing risk assessment limitations.
The session's outline includes a lecture on risk, group discussions on cases, and a summary/Q&A.
Risk is defined as the possibility of loss (immediate, delayed, long-term, chronic), and introduces the dynamic vs actuarial approaches.

General Principles

Risk assessment affects all aspects of psychiatric practice.
A holistic, individual, and responsive approach is crucial.
Multidisciplinary collaboration is essential.
Risk versus protective factors are considered.

Actuarial Approaches

Actuarial approaches utilize records and statistics to calculate risk.
This approach is structured, empirically-based, and objective.
Questions of rigidity and reliability are raised.

Clinical Assessment

Clinical assessment is conducted by clinicians and is historically informed.
The aim is to be responsive and dynamic.
Potential biases and blind spots in clinical assessments are recognised.

Risk Assessment

Risk assessment considers the size and acceptability of risk, along with dangerousness and likelihood.
Risk assessment is a dynamic process.
A comparison between clinical and actuarial assessments (with their respective advantages and disadvantages) is presented.
It is impossible to eliminate risk at an individual level.

Why Formulate Risk

A working model for risk assessment is presented, including patient liaison and bringing information together.
Intervention and communication are crucial aspects of risk assessment.
A reference is included connecting risk formulation with the HCR-20 version 3.

Assessment Linked with Action

The process of risk assessment involves establishing context, identifying, analyzing, evaluating, treating, and monitoring risks.
This approach of risk assessment has an emphasis on ongoing communication and consultations.

Risks in Mental Health

Issues are discussed using examples from the news and case studies, including the violence by individuals with mental illness.

Risk Domains in the Mental Health Act

The domains of risk to self, risk to others, and risk to health are outlined.

Self Harm I

The Royal College of Psychiatrists indicate that 10% of the UK population experiences self-harm.
Common contributing circumstances include difficult personal circumstances, past trauma, social/economic deprivation, and substance misuse.

Self Harm II

Self-harm is positioned as a risk in itself, a communication of distress, and representing ambivalence towards life.
People who self-harm have a significantly increased risk of suicide.

Suicide I

England and Wales suicide rates are increasing (11.4 deaths/100,000 in 2023, which is a 7.6% increase from 2022).
Males account for around 75% of recorded suicide deaths.
Suicide rates showed a downward trend since 1981, but recent years have shown an upward trend, with 2023 producing the most deaths since 1990.

Suicide II

Highest age-specific suicide rates in 2023 for men aged 45-49 (25.5/100,000) and women aged 50-54 (9.2/100,000).
Hanging and poisoning are the most common methods of suicide.

Suicide III

Most suicides are linked to mental disorders, with an estimated 21% population attributable fraction.
Mental disorders significantly increase the risk of suicide (e.g., 8 times higher for people with mental disorders compared to the general population).
Specific mental disorders associated with higher suicide risk include psychosis, mood disorders, substance misuse, and personality disorders.

Suicide IV

A pie chart illustrated the primary diagnoses for UK suicide cases in 2023.
Affective disorders (depression or bipolar disorder) are the most frequent primary diagnoses, followed by schizophrenia.

Defining Risk Factors

Static risk factors are unchanging aspects that increase risk, such as childhood experiences, age at first diagnosis, and demographic characteristics.
Dynamic risk factors are aspects that change over time, including mental state, support systems, and the wider environment.

Risk Factors for Suicide

Previous suicide attempts or self-harm increase suicide risk.
Male gender is a significant risk factor (3x higher likelihood).
Concurrent mental disorders and previous psychiatric treatment increase risk.
Unemployment, homelessness, social isolation, loneliness, alcohol/drug abuse, and physical illness are additional suicide risk factors.

Protective Factors

Social support (not living alone), having children at home, a sense of responsibility, strong religious faith, problem-solving skills, and strong connections/identity are protective factors against suicide.

Asking about Self-Harm: Examples

Question prompts for exploring self-harm are provided.

Serious Untoward Incident

Incidents impacting patients, families, or staff are addressed with a focus on learning and preventing future harm, instead of blaming.

Case Scenario 1

A 49-year-old male presenting with suicidal ideation, recent intensification of thoughts, history of previous attempts, and a protective factor of children abroad is used as a case study.
The case also considers how the risk might be rated.

Case Scenario 2

A 29-year-old man with schizophrenia, multiple risk events, weapons history, violence to strangers, and multiple residences is presented as another clinical case.

The Christopher Clunis Inquiry

Information about an inquiry into the treatment of Christopher Clunis is furnished.

Continuity of Care

The Ritchie enquiry's findings highlight issues of inconsistent and inadequate care continuity with patients moving between multiple care providers.

CQC Findings

The Care Quality Commission highlighted issues with inconsistent risk assessments, inadequate care planning and engagement, and poor risk mitigation associated with the discharge of one patient.

Violence and Mental Illness

The presentation highlights an overemphasis on homicides by people with mental illness, which deviates from actual risk.
Sociodemographic and economic factors and substance misuse can be major contributors to violent acts, apart from mental illness.
People with mental illness are more often victims than perpetrators of crime

Violence and Mental Illness (page 37)

A modest link between violence and mental illness remains a focus in recent studies, but methodological issues and possible biases in studies lead to limited conclusions.
Studies have shown little conclusive results on the link between schizophrenia and violent acts.

Rates of Violence Compared

Studies compare violence rates in people with schizophrenia, with and without concurrent substance abuse, against matched control groups.
Data shows significant increase of violence rate in individuals with both schizophrenia and concurrent substance abuse disorders.

General Principles (page 39)

Factors in history (past violence, engagement, substance misuse, domestic violence) are presented as risk indicators.
Environmental indicators (access to victims and weapons) are discussed as risk factors.
Mental state factors (symptoms of threat/control, violence-related thoughts, suicide, psychopathy, or restricted insight) are discussed.

Types of risk

The presentation lists the types of risk as: risk to self, risk to others and risk to health.

Risk to Health: Some Examples

The presentation contains examples of risk to health, such as severe psychotic symptoms, squalid/uninhabitable homes, and symptoms of depression that accompany these conditions.
Risk to health, including severe conditions or lack of adherence to medication, also occurs.

Risk From Others

The likelihood of harm from others, including physical harm, sexual violence, emotional abuse, unlawful restrictions, or financial abuse, is addressed.
This presentation explores the importance of safeguarding considerations for individuals vulnerable to violence from others.

Risk from Others (page 44)

Individuals with mental illnesses are frequently victims of violence more than they commit acts against others.
The presentation explores diverse forms of violence such as institutionalisation, ostracisation, verbal, physical, and sexual abuse, exploitation, and retraumatisation.

Other Risk Considerations

A list of additional risk factors considered important to identify and discuss.

Clinical Tools (NHS - Psychiatric Risk Assessment)

A list of particular features pertaining to identifying risk to self, presented as a tool for psychiatric assessment.

Evidence of harm TO OTHERS

A list of harm indicators towards other individuals or groups.

Evidence of risk of ACCIDENTS

The presentation provides various cases of risk to self due to accidents.

Evidence of risk to CHILDREN or VULNERABLE ADULTS

Discussions of factors of risk towards children or vulnerable adults, including Multi-agency Public Protection Arrangements (MAPPA), Multi-agency Risk Assessment Conference (MARAC), disclosure of abuse, non-compliance with treatment plans, and circumstances of substance misuse.

Physical Health risks

Factors are identified that pertain to physical health concerns, such as access to general practitioners (GPs), necessary investigations, and recommended treatments.

Substance Misuse Risks

The presentation lists the indications and risks of substance misuse, such as IV use, needles, overdose, and sex work.
The presentation includes considerations for child safeguarding if the patient has children or if there are children in the household.

Clinical Tools, HCR-20

The Historical/Clinical/Risk Management-20 Scale is introduced and details some of the pertinent features in clinical tools, such as past and present features, and categories of risk.

...AND IT'S NOT ALL ABOUT RISK ASSESSMENT

The presentation highlights the findings of a survey regarding risk assessments' practice in the field.
It explores potential over-reliance on risk assessment tools, the importance of interaction with patients, and the limited predictive value of such tools.

Vignettes

A few brief case examples (vignettes) are included.

Considerations

Various questions are raised about risk management practices' potential shortcomings, including over-risk-aversion, duty of care, and the role of technology in the future.

Summary and Questions

An understanding of risk and its clinical significance is highlighted.
Crucial characteristics of effective risk assessments (being current, precise, individualized, and responsive) for successful risk identification are stated.
Risk assessment does not prevent but rather informs and assists in mitigating risks.

Other Resources

A list of available resources for further support and information on mental health, including suicide prevention and child safeguarding, are provided.

References

A list of references supporting the material presented in the presentation is detailed.

Studying That Suits You

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Description

This quiz explores risk assessment practices in clinical psychiatric settings, including the evaluation of suicide and harm risks. It emphasizes the importance of understanding different risk types and factors, while also discussing the practical implications of both actuarial and dynamic approaches. Prepare to engage in group discussions and apply assessment tools in the context of mental health.