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New Evidence in Assessment of Risk
Effective risk assessment should be based on evidence. What I mean by this, is to assess whether someone is at risk of coming to harm or harming others, we need to base that assessment on some sound research information. That might be knowledge about the person themselves, or perhaps some national research about risk factors and what causes some people to be at higher risk than others.
New Risk Factors in Suicide
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, based at Manchester University, published their annual report earlier this year and highlighted some interesting research about risk factors which may provide new and useful information to guide your own risk assessments.
The report can be viewed at: http://www.bbmh.manchester.ac.uk
Here were some of the key, and maybe slightly surprising findings:
- Middle aged men are a high risk group – the report suggests there’s things about middle aged men, not just the fact that they are male and middle aged that presents a risk factor, such as job insecurity, financial stresses, overuse of alcohol and maybe isolation. This is maybe a group that finds it difficult to seek help and stick with the help so monitoring is an important issue to prevent risk.
- A new factor in the report was that people being seen by Crisis Resolution/ Home Treatment teams were at higher risk of suicide. Well you’d think it was the opposite – but the reality is community services are under a lot of pressure and maybe seeing people at a very high risk who might have previously been admitted to hospital is something to be aware of.
- Where treatment was being offered was a factor – so people were at higher risk if they were admitted to hospital away from home. Again pressure on services has resulted in a struggle to find local beds.
- Changes in types of suicide and availability of drugs has been a factor. So suicide by overdose of opiate based painkillers has risen, so staff should be aware of people hoarding amounts of painkillers, albeit obtained over the counter.
- We often hear that having family around you is a protective factor – that’s right, but the report shows we need to work closely with those families and listen to their concerns.
- Long term physical ill-health is also a risk factor. This highlights the need for good physical health assessment when someone is admitted to your service. Good physical health care can reduce suicide risk.
- Finally the report noticed a rise in deaths by suicide amongst younger men who were in-patients. The researchers will be doing more work to understand the reasons behind this.
David Beckingham – QCS Expert Mental Health Contributor