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Keeping service users safe is basic requirement in caring for people with mental health problems. Equally, there's a lot of emphasis at the moment on the need to ensure people can make choices and decisions over their own-day-to-day lives in order to promote recovery. This apparent contradiction in approaches to managing risk is explored in a new document just published jointly by the Centre for Mental Health and the NHS Confederation, titled Risk Safety and Recovery by Jed Boardman and Glenn Roberts.
The document describes these two 'poles' of risk assessment and how they might be reconciled. It highlights all the factors that staff are required to consider in managing risk. Consider a case example of someone in a care home refusing to have a bath:
- Do they have capacity to make that decision?
- Does their mental state mean their decision-making ability changes?
- What does the staff's duty of care mean in relation to keeping someone clean?
- Are there any safeguarding issues involved if the person doesn't stay clean?
- What about their right not to have a bath if they don’t want one?
- What about health and safety requirements for the staff and other service users?
So this new guide acknowledges the risk dilemmas for staff. It also acknowledges that a lot of the focus on risk has been about very high risk issues such as physical harm to others or oneself, and that may have encouraged a more defensive approach to risk. Most risk management is going to be about more 'ordinary' risks like the example I've just given. Equally the report is concerned that a focus on the idea of positive risk taking, that is allowing people to take risks as part of a move to more independent living can leave staff feeling uneasy. Will they be supported by managers if things go wrong?
The document provides some useful pointers in how to think about risk that offers a balanced approach. It stresses the importance of taking a risk history, so that the indicators of risk for this person can be identified. It goes on to guide staff in how to involve the person in drawing up a risk plan that keeps them safe, but one that they can feel they have had an input in making. It also stresses the usefulness of involving other staff and the person's family in drawing up such a plan. They call this person-centred safety planning.
*All information is correct at the time of publishing