Risk management programme
The programme aimed to help improve the assessment and management of clinical risk in mental health services. Specifically to work with specialist (secondary) mental health services, to support services to achieve a balance between positive service user assessment and management and ensuring safety to self and others. This programme has now closed.
Risk Assessment and Risk Management
Policy and guidance
Best Practice in Managing Risk: Principles and Evidence for Best Practice in the Assessment and Management of Risk to Self and Others in Mental Health Services This framework document is intended to guide mental health practitioners who work together with service users in managing risk of harm. Dr Richard Whittington and team from Liverpool University completed this work for National Risk Management Programme.
We commissioned a project to examine how best to support implementation of the best practice guidance. (To view this website you will be asked to follow a registration process.)
We examined how different organisations view risk and jointly develop risk agreements. This work was led by Elizabeth Fellow-Smith, West London Mental Health Trust, based on pilot work developed in Hounslow and NPSA Seven Steps to Patient Safety. The work breaks down issues of language and organisational culture. A final report detailing findings of this project is expected in December 2007.
To view project document including project overview and minutes click here.
Evidence
Further evidence can be found on forensic mental health research and development website. Including the systematic review of prevention strategies for the population at risk of engaging in violent behaviour.
Information
Risk Management Framework: Independence, choice and risk: a guide to best practice in supported decision making Best practice guide developed by CSIP Social Care Programme.
Standards Inspectorates:
National Health Service Litigation Authority (NHSLA) monitor whether trusts are achieving the appropriate level of care standards through Clinical Negligence Scheme for Trusts (CNSTs). New CNST acute standards were piloted in summer 2006 and mental health, learning disability and ambulance service standards are currently being piloted (summer 2007).
MONITOR regulates and allocates a risk rating for NHS Foundation Trusts.
Healthcare Commission assess and report on performance of NHS and independent healhtcare organisations. Assessment includes annual staff and patients surveys and annual health checks.
Carer and Service User Consultation
Our consultation with service users and carers was guided by Making a Real Difference (HASCAS 2005).
Service Users' Comments We commissioned ARW Training & Consultancy to facilitate two service user workshops across England. The workshops focused on perception of risk, factors which influence risk and the Care Programme Approach (CPA). Delegates were invited who were currently, or had recently been, in contact with mental health services. Service user views on risk and wider issues can be viewed here.
Carers' Comments We attended a Carers in Partnership network (NIMHE West Midlands) and a Carers Network at London Development Centre to listen to carer's views and experiences of risk. Carers comments on risk and wider issues can be viewed here.
Relevant policy and research
Mental health service users and their involvement in risk assessment and risk management identifies key issues and findings raised by service users about risk taking. The paper suggests service users' views are essential for valuable decision making and promotes open discussion of risk.
Real Choices, Real Voices (CSCI) consultation with service users, carers and health providers found service users wanted to reach their potential by being supported to take risks. Families should be provided with the same training and tools as care staff to enable appropriate risks to be supported.
Briefing paper: information sharing and carers (NHS SDO Jan 2006) .Good practice advise for service providers
10 Essential Shared Capabilities describes skills and capabilities practitoners should have when working with service users to ensure participation and engagement and to promote safety and positive service user risk management.
Risk perception and mental illness
Policy and guidance
As part of the programme we commissioned research into perception of risk associated with mental illness. Public and media perceptions of risk to general public posed by individuals with mental ill health, led by Dr Diana Rose from Institute of Psychiatry, examined previous literature and makes recommendations to reduce negative and stigmatising perceptions of mental health problems.
Information
For more information on SHIFT, please click here
For more information on National Social Inclusion Programme please click here
Serious and Untoward Incidents
Policy and guidance
An Organisation with a Memory (DH 2000) examines lessons which can be learnt from adverse healthcare events and makes practical recommendations to influence organisational culture.
NPSA Seven Steps to Patient Safety in Primary Care lists actions that primary care organisations, staff and teams can take to improve patient safety locally and help meet clinical governance targets. Issues include addressing blame culture and inter-agency communication.
NPSA Manchester Patient Safety Framework is a tool designed by National Patient Safety Agency to assess improvements made within NHS to place patient safety at the central of the organisation.
Preventing Suicide: A toolkit for mental health services (2003) commissioned by NIMHE will assist mental health services in assessing their performance in addressing the recommendations of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness.
Evidence
Review of homicides by patients with severe mental illness (March 2006) identifies the small number of homicides which are linked to mental illness. This independent report by Professor Anthony Maden, provides recommendations for reducing the number of homicides committed associated to mental ill health while acknowledging violence cannot be completely eliminated.
National Confidential Inquiry into Suicide and Homicide by people with mental illness Centre for Suicide Prevention (CSP). This national research project was funded by National Patient Safety Agency (NPSA) to make recommendations for improving clinical practice from data collected relating to homicide and suicide. Safer Services was the first report published by CSP in 1999, followed by Saftey First in 2001 and a further report is expected in Autumn 2006.