Risk assessment and safety planning in mental health nursing services

Background Despite risk assessment and management being a core aspect of mental health nurse’s practice, little is known about how they conceptualise risk, or how their everyday practice in this area is informed or... [ view full abstract ]

Background
Despite risk assessment and management being a core aspect of mental health nurse’s practice, little is known about how they conceptualise risk, or how their everyday practice in this area is informed or performed from the perspective of recovery-oriented mental healthcare.

Study aim
The overall aim was to explore practices, policies and processes around risk assessment and safety management within mental health nursing and within a number of mental health services in Ireland.

Method
Data for the study were collected using a mixed methods design involving an anonymous, self-completed survey and documentary analysis. A total of 381 adult mental health nurses completed a survey about their practices, confidence and attitudes in relation to risk assessment and management. Descriptive and inferential statistics were generated in the analysis. In addition, risk assessment and management related documentation (N=123) was received from 22 Directors/Acting Directors of Nursing. Ethical approval was received from the University’s ethics committee.

Findings
Respondents conceptualised risk narrowly with risk to others and to self being the main focus of assessments while risks from others, risks from treatment or contact with services and risk of social exclusion were largely neglected. This dovetailed with the documentary analysis findings which indicated that organisational policies and procedures are orientated towards the avoidance of adverse or dramatic risk rather than the promotion of positive risk taking opportunities. The absence of guidance on positive risk taking was reflected in nurse’s lack of confidence and knowledge in this area. There was no evidence of a recovery- orientated strengths model being adopted as a basis for care planning and a lack of meaningful engagement with services users was also found.

Conclusions and implications
Mental health practitioners require training to enable them to acquire the knowledge and competencies to practice risk assessment and management in a recovery-orientated manner. In addition, organisations should review their policies on risk and safety to ensure that they have a comprehensive workable definition of risk and that they provide those who use the service with opportunities for positive risk taking.