Mental health articles

Risk categories together with the various factors under each should assist nursing staff and other practitioners in their assessment and management of risk within their daily clinical practice. However, they should be used as a helpful aide-mémoire or as a tool to support professional judgement based on practical experience. This section is designed to help the reader examine the risk categories we are suggesting as well as the individual factors under each of the headings set out later on in this section. Seven broad categories are considered:

suicide;

neglect;

aggression/violence;

risk associated with disability;

physical/medical risks;

self-harm;

other risks.

Risk categories and their constituent factors can be used to develop tools that systematically gather these data in relation to individual service users. However, a few broad considerations will arise in practice:

Provision for ‘past’ and ‘current’ (and possibly ‘potential’ in relation to the ‘current’ category). A frequent question raised by practitioners is, ‘What constitutes “past” and what constitutes “present”?’ One approach is to provide a cut-off date in the operational policy and on the risk documentation, for example, three months. However, this approach can lead to various problems including occurrences that are just a few days away from the cut-off point. Under which category should they be entered?

Documenting ‘potential’ risks under the ‘current’ section. Arguably anything could be described as ‘potential’. Therefore, the preferred option is to rely upon good clinical judgement, based upon sound professional approaches and experience. As far as possible where areas of potential confusion occur, it is preferable for practitioners to check out thinking, ideas and concerns with colleagues with a view to arriving at some sort of consensus on the issue in question.

Inclusion of tick boxes for ‘yes’, ‘no’ and ‘don’t know’ against each of the category factors (creating the opportunity for practitioners to highlight areas where more information or clarification is required by ticking the ‘don’t know’ box). However, some documentation in use around the country only has provision for ‘yes’ or ‘no’, which can lead to people being forced to tick one of these when, in reality, it would be far more appropriate to be recording some items as ‘don’t know’.

Tags: categories, risk, risk assessment