A recent inquiry from the House of Lords around the use of Deprivation of Liberty safeguards suggests that these are being used, in some cases, to restrict people with mental ill health and learning disability rather than protect them. The findings highlight the way people might be subject to decisions that do not allow them basic freedoms due to a perception that they may be vulnerable and at risk. This got me reflecting on the day-to-day use of risk assessments in care and how important it is to use these correctly.
An illustrative example
A young woman I know displays significant challenging behaviour when she is very excited. She cannot manage her emotions, happy or angry, when they become extreme and overwhelm her. The outcome is that she is violent to those in her immediate reach and also to herself. Because of this behaviour and an event where she reacted severely to a visit to her family by almost causing a car accident, an in-depth risk assessment was called for to protect her and others from harm.
I was first aware of the existence of a new risk assessment when I noted that she had not been out of the home for a number of weeks, except to walk about the grounds. There were no incidences of her being included in trips to the supermarket, to daytime activities or to the pub in the evening. This was odd, because prior to the event in the car, she had been a regular at the shops and in the local. I asked the team leader why this was and was told that her risk assessment had effectively banned her from any activity that she might enjoy!
Consider your approach
Of course, this was not how it was written, but on examination I read that the safeguards put in place to reduce the incidence of her extreme behaviour were to avoid situations that might over-stimulate her. It was not until I pointed out the restrictive nature of this, that the staff reviewed the risk assessment and we arrived at a solution where we identified the triggers and warning signs around outbursts and took action to de-escalate before a problem occurred. We also increased the type and level of support needed and ensured staff received training and support to help them deal with potential crises.
If you have written a risk assessment that might prevent an activity, please think about how it impacts on the rights and freedoms of those you support. Risk assessment is powerful in helping us predict problems and safeguard against them. It demonstrates that we have considered client safety when undertaking activities and that we can evidence our process of planning to ensure fewer adverse events. It should never be the reason we don’t do something, but instead should be the detail of how we do something safely.