According to Martin Rogan, the HSE Assistant National Director, Mental Health “Safety is central to the provision of quality mental health services. However, adverse events do occur, sometimes with tragic personal consequences.” Therefore, protecting patients and others from harm is a key priority and risk assessment and management is an indispensable component of providing such protection. We would be expounding on the Risk Assessment undertaken for a service user being detained by, The Mental Health Act of 1983, which allows for an Approved Mental Health Profession(AMHP forthwith) to admit an individual thought to be suffering from a mental disorder to the hospital “where it is in the interests of their own health, or safety, or for the protection of the people” which is the spring from whence our argument springs from as the Risk Assessment is based on a service user mentally challenged This particular care user is of Is of peculiar interest to me as I have been opportune to serve the user on numerous occasions while assisting my supervisor, and to a reasonable extent understands the care user’s dispositions and tendencies making him a perfect fit for the risk assessment. Further, the importance of risk assessment cannot be over emphasised even more, in the care giving profession as ours and this paper is written following the risk assessment of the aforementioned care user who exhibits violence and aggression towards self and caregivers on numerous occasions. This is of particular interest to us because of section of the Mental Health. Which strengthens our case for the need to identify and understand the risk to this service user.
Risk Assessment is the very foundation on which the construct of Intervention is built upon and, if properly executed could avert future problems not only for care user both giver as well. There is no gainsaying that assessment precedes effective delivery of healthcare. Sharing the same sentiment is (Open University, 2015), where it was argued that risk assessment is not just the preliminary part of the intervention rather, it is an ongoing component within the cycle of delivery. In view of the importance of risk assessment and safe person-cantered practice, on the 14th of December 2016, the Word Health Organization (WHO) organized On safer primary care which explored the nature and magnitude of harm in the primary care setting from a number of different angles with the major objective of raising the awareness about the causes and consequences of unsafe primary health, and to increase knowledge about how to design and deliver safer care. Away from International examples of the importance of risk assessment and management, Another evidence indicative of the prime position of risk assessment is the “Safeguarding Vulnerable Groups Act of 2006” which makes it a statutory duty on all those working with vulnerable groups to register and undergo an advanced vetting process with criminal sanctions for non-compliance. the Having established the importance of risk assessment, we appraise its contribution to safe-person cantered practice, taking cues from (Open University, 2015) where it was posited that it ensures that; Individual needs are accommodated, it minimizes risk, accountability obligations are met and lastly supports practice development. In view of the above, we proceed to show why the user assessed situation put them at risk and subsequently, interventions required to address such risks head on.
The user selected for the risk assessment is one with relapse episodes of aggression and violence towards self, givers and the environment. However, we would be expounding on why it puts the user at risk. In setting the tone for our argument, it we reference the National Health Mental Policy, A Vision for Change (2006). This policy places the service user at the center of mental health services and promotes a recovery approach to mental ill health. Another case in point here is the Quality Framework, Mental Health Services in Ireland (2007) by the mental health commission. The framework was a road map and enabler for mental health services in striving for high standards and good practices in the sector. In view of the importance attached to mental health services, it is imperative we appraise why the user’s situation put them at risk and a need to intervene after a thorough assessment. The Mental Health Act (1983) is the main piece of legislation that covers the assessment, treatment, and rights of people with a mental health disorder. People detained under the Mental Health Act need urgent treatment for a mental health disorder and are at risk of harm to themselves or others.
Research have shown that 20%-60% of the deaths by suicide occur among people who have a mood disorder. Which helps put our user’s case into perspective, as he easily relapses into aggression and violence whenever his moods alter. Again, Suicide among such people is more common among those with more severe and/or psychotic symptoms, with late onset, and with coexisting metal and addictive disorders evident in our user.
Another way this user possess risks to themselves is through self-mutilation, in one of the episodes of aggression when the user had the opportunity to step out of the ward for 2 hours. The user relapsed into the aggression and violence mode, started hitting their own head on the wall uncontrollably just a few minutes after being examined to be stable, this happened, without any form of provocation that warranted such response from the user.
However, it is instructive to state that, self-mutilation should not be confused with suicide attempts. Nevertheless, (Zlotnick C. et. al., 2009) suggests that those with mental illnesses are more likely to self-mutilate, with one study of psychiatric outpatients claiming that 33% reported engaging in self-harm in the previous three months. Furthermore, self-mutilation is an early predictor of suicidal behaviour. About half of all people who kill themselves have a history of deliberate self-harm, an episode having occurred within the year before death in as argued by (Ovenstone, l. et al, 1974).
Having clearly identified the risks the user possess to himself and in some cases, others, it is a matter of necessity that we consider interventions necessary to mitigate such risks. As identified in the risk assessment, there are four areas of risk which are relevant for consideration when managing people with mental health issues, these view is also supported by (O’Rourke and Hammond, 2005) and are as follows;
Vulnerability, Self-harm/suicide risk: The service user can be at risk from self-harm, intentional injury or killing oneself, action/behaviours destructive to one’s own safety or health; Mental instability: The service user can be a risk to self or others because of fluctuating and/or unpredictable mental health function especially in relation to command hallucinations and other “at risk” psychotic or disturbed phenomena; Risk to others: The service user can be at risk of causing harm or danger to others or encouraging/involving others in the causing of harm or injury to others, it is in view of these real and perceived risks that we propose the following interventions I would implement to reduce the risks to the user and others.
The following interventions would be employed.
Instill hope without invalidating despair. Indeed, after every episode of aggression and violence, he breaks down when back in his default mental state, starts apologizing and talking about how sorry he is for everything that just happened. In this case, I support an intervention where I would encourage the user to be hopeful and that it shall pass and whatsoever that happened is not his faults and that everything would be fine with time.
Help client to avoid, minimize, or respond differently to immediate stressors. I would pay careful attention to identify stressors that lead to such episode of relapse and try my possible best to help the user avoid and overcome such triggers, so going forward, they are able to adequately manage their emotions in the occurrence of such event
Encourage structure in the user’s life including homework and scheduled activities. This intervention is needed to create a semblance of balance in the life of the user and forestall triggers that results from irregular lifestyles as I have recorded while studying the client. This is expected to eliminate avoidable triggers like the one that results from imbalance in lifestyle.
Listed above are three major interventions I intend to implement.
In evaluating the outcome captured in the plan of care above, it is imperative to explicitly outline what counts as desired results and what does not. Firstly, I would look out for signs that does not reinforce the self-defeating idea that the user is responsible for his own predicament as he usually does after every episode. Again, in evaluating the outcome of helping user to avoid triggers, avoidance is only a short-run solution and may not be sustainable in the long run, therefore, after helping clients maintain exposure to such triggers, we look out for signs that confirms that the user has successfully overcome the effect of such triggers. Lastly, in evaluating the outcome of the structure and balance introduced in the user’s life, I would look out for indicators relating to how the balance introduced in the care user’s life and how responsive is the user is to scheduled activities. Do they take initiatives, is there a noticeable change in behavior towards the commencement of a particular activity. These and more are the indications to be used in adjudging the efficacy of our intervention.
Conclusively, we have been able to raise arguments, drawing reasoning from scholarly publications, International and National Health Journals, highlighting the importance and usefulness of risk assessment and management. We drew the cogent insights that there are universally accepted a tool for risk assessment, however, there are industry and nationally accepted tools, which was used above providing useful insights into building a risk assessment and improving the service rendered to users.