UNIT 8 UNDERPIN RISK MANAGEMENT - Global …...3 KEY PRINCIPLES AND VALUES THAT UNDERPIN RISK...
Transcript of UNIT 8 UNDERPIN RISK MANAGEMENT - Global …...3 KEY PRINCIPLES AND VALUES THAT UNDERPIN RISK...
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Table of Content
1. Key principles and values that underpin risk management
2. Working together within the risk management process
3. How to involve carers and family members effectively
4. Risk factors that should be considered during risk assessments
5. The role of suicide reduction strategies
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KEY PRINCIPLES AND VALUES THAT UNDERPIN RISK MANAGEMENT
A risk assessment involves collecting information about an individual through the processes of
observation, communication and investigation. It is not a one-off planning event but an ongoing
assessment to ensure that individuals remain safe but are also enabled to live their life in the way
that they want to.
In order to be effective, risk assessments must involve the individual, any carers or advocates that
they may have, their family and friends and any health professionals with whom they are involved.
All of those involved must speak freely with each other and this includes raising any concerns about
an aspect of a risk assessment that they may not be happy with. Each time a review takes place, all
of the people involved will need to ensure that any amendments made are discussed thoroughly
before all parties sign to say that they are satisfied with any changes.
Positive risk-taking in addition to risk of harm: any risk that is presented when planning an
individual’s care and support should be considered and not seen as a reason to dismiss
something that the individual wants. Being open-minded about all aspects of risk will build the
individual’s confidence and self-esteem and therefore enable them to live more independently,
which is the overarching aim of person-centred care.
Considering a range of types of risks: there are risks in every aspect of life and these will
vary in severity dependent upon each individual. A risk assessment should be as broad as
possible so that risks in all areas of the individual’s life are considered; this way nothing can
be missed and there is a much greater chance that the individual will remain safe.
Evidence-based approach: this kind of approach uses professional knowledge alongside
well researched interventions in order to ensure that risks are not going to make anyone face
deliberate harm. It is also based on knowledge of the individual, such as their characteristics
and values, all of which combine to ensure that risk assessment planning is thorough and
based on what is already known rather than projecting or guessing about something.
Forward planning to reduce risk of harm: an informed choice can only be made if the
individual has all of the information available to them. This may mean that information has to
be presented in other formats or by use of an advocate. Failure to give all of the information to
someone breaches person-centred care principles and may put the individual at unnecessary
risk, and so using this method to plan ahead will be most effective at ensuring that the risk of
harm is significantly reduced.
Specifying warning signs: a warning sign can be anything which alerts others to the fact
that an individual is going to be put at risk of harm. For example, if a risk assessment
concluded that the individual was able to administer their own medication, a warning sign
around this might be that they tend to become forgetful due to a stressful situation. This kind
of warning sign must be clearly stated within a risk assessment and within the care and support
plan so that an intervention can be put into place before it causes harm.
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Contingency planning: contingency planning means preparing what to do if there is some
form of crisis, emergency or a significant, sudden change in the individual’s needs. Everyone
involved in a care and support plan should know the role they play in contingency planning
and the individual may also have some self-help strategies as part of their own planning. For
example, someone who experiences bipolar disorder may need to have their financial
responsibilities passed to someone else during a manic phase and so a contingency plan for
this might include the individual being aware of warning signs and letting the person who takes
this responsibility know as soon as possible.
Specifying roles and responsibilities: an individual’s family, friends and carers are likely to
be a big part of their life and person-centred care acknowledges this by including them in all
aspects of care planning. This is useful as everyone involved with the individual knows what
plans are in place and it gives confidence to everyone that communication is open, and everyone
knows who is responsible for what aspects of the individual’s care and support. In addition, all
healthcare professionals should know what their roles and responsibilities are so that if there
are any questions, the individual knows who to contact.
Anti-discriminatory practice: if an individual is subject to discrimination during a risk
assessment, this may mean that they are unable to take some of the risks that they want to in
order to make their life meaningful. All professionals involved in a risk assessment should
ensure that they are inclusive and do not base their decisions on inaccurate stereotypes; they
should also suspend their own value and belief
Regular review: reviews must take place to check that the assessment findings that have been
applied in a care and support plan are still relevant. It may be that a person’s condition has
improved or deteriorated, in which case changes will need to be made in order to make sure
that the individual remains safe. The individual must be as involved in a review as they were in
an initial assessment and their wants and needs are still a priority when new risk assessments
are taking place.
Effective record keeping: effective records must be kept so that it is clear what has been
decided, when and by whom. Records must be factual and presented in a way that is fully
accessible by the individual. They must ensure confidentiality and be made available to the
individual should they wish to see them and every entry into a record of planning must be signed
and dated.
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Case Study – Scott
Scott has bipolar disorder, which is usually well controlled by medication. Due to
incidents of attempted self-harm prior to a diagnosis, Scott still has a social worker and
a care coordinator with whom he meets regularly. He has requested a review of his
care and support plan because he feels that he can now return to his university degree,
which was suspended because of the stress it caused him, leading to self-harming
behaviours just prior to his diagnosis.
His care coordinator tells him that this will be subject to a risk assessment because
there are a lot of things to take into consideration. As this is what Scott wants he
believes that he should not need a review but agrees to go along and brings his
mum with him who is reluctant to agree with Scott that a return to education is his
best course of action, just at the moment.
A representative from the university also agrees to attend and the meeting is very
successful. Scott is going to be given a mentor whilst at university who will be
available to him at any time, if he starts to feel stressed or anxious about what is
expected of him. He will return on a part-time basis and the university has agreed
that some of his lectures can be attended by an online forum. His goal is to
complete his first year by the end of May and then he will meet with the university
representative to see what his options are for the next academic year.
Scott's social worker has arranged for him to get a taxi to the university, as it is quite
close, but Scott does not yet feel confident enough to either walk or get public
transport. Scott may need extensions to university deadlines but knows he must be
as proactive as possible in getting things completed to normal deadlines and will
discuss any issues in this area with the relevant lecturer.
Everyone present at the meeting, including Scott, is very pleased with the outcome
and a review is set for three months to see how things are progressing.
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WORKING TOGETHER WITHIN THE RISK MANAGEMENT PROCESS
Everyone who works with an individual should have some form of role within a risk management
process because everyone will have some information which is relevant to the risks that they are
enabled to take. As ever, the individuals themselves should be the focus of this process and it should
be considered what they can do in order to promote risk-taking rather than on what they cannot do
to try and discourage risk-taking.
The risk management process is, therefore, a collaborative task that should form part of a person’s
care plan assessment, the findings of which should be recorded in the plan so that they are
accessible to everyone with whom the individual works.
WHY AGENCIES AND WORKERS SHOULD WORK TOGETHER WITHIN THE RISK MANAGEMENT PROCESS
When everyone works together, a strategy of ‘managing risk positively’ can be applied, which
means that benefits and potential costs of risk are weighed up so that the individual is still enabled
to have their wants and needs met but in a way that still ensures their safety.
This form of risk management process has many benefits, which include:
The empowerment of individuals: working together empowers individuals to take control
of their own life – they are seen as an equal partner in the risk assessment and care
planning procedure, which can be a significant factor in increasing their self-esteem,
resilience and confidence.
Risk-taking is assessed in a holistic way: when all parties are involved, this helps to
ensure that risks are not just assessed in terms of the individual’s medical needs but in
terms of their other needs as well such as social, religious and dietary.
All parties involved are aware of their role in the process: this actively increases
ownership so that if something untoward does occur those who are responsible can take
responsibility and ensure that steps are put into place to learn from what has taken place.
The development of trusting relationships: for any care assessment which involves risks
to be successful, trust must be the foundation. These work in a mutual way between
individuals and professionals, carers and family members and professionals and individuals
and their carers and family members.
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Enabling the individual to learn from experiences: there will inevitably come a time when
a risk assessment does not predict something that ‘goes wrong’ within a plan, which may be
something minor or something which puts the individual at risk of harm. When individuals
can learn from this, they become more self-aware and this can help them to plan more
realistically for the future.
Developing an understanding of what works well and what does not: all parties
involved need to be aware of what works and what does not. These can be assessed by
completion of a simple document where everyone involved gives their opinion about how
things are progressing and what needs to be reviewed as it does not meet the needs of the
individual or may be putting them at risk.
Ensuring a consistent approach to risk management processes: everyone must be
consistent in their approach to risk management as mixed messages from professionals and
others can cause frustration and confusion to individuals who may experience further mental
health distress because of this.
Ensuring that health professionals are aware of their duty of care within the process:
working in a collaborative way helps professionals to ensure that their duty of care towards
an individual is clear and is not breached by any aspect of the risk assessment process.
Professionals may find it useful to liaise about areas of their duty of care that are vague and
can find guidance from others to be very useful.
Accurate records are kept protecting the individual: all decisions must be recorded in a
legal and accurate way to ensure that if these need to be referred to, it was clear who agreed
to what actions and who was present when a risk assessment meeting took place. This is not
to place blame on anyone should something happen but ensures that everyone is consistent
in care and risk management planning in line with appropriate policies and legislation.
HOW AGENCIES AND WORKERS SHOULD WORK TOGETHER WITHIN THE RISK MANAGEMENT PROCESS
All parties involved should meet, which should include the individual and any carer, family member,
friend or advocate whom they wish to have present with them. All parties should be enabled to have
their say about the risks that have been proposed without fear of judgement or discrimination.
Everyone should be aware of the plans that have been put into place and these should be fully adhered
to by all parties to ensure that care and support is provided consistently.
Should a review need to take place, this should be with all relevant people and should always be
carried out in exactly the same way as the original assessment with the individual’s wants and needs
at the centre of any decisions that are taken. It should also be kept in mind by all people involved
that some risks cannot be completely removed just because individuals may be classed as
vulnerable because of a mental health issue. This would almost certainly cause them to feel
disrespected and would have a negative impact on their overall quality of life.
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HOW TO INVOLVE CARERS AND FAMILY MEMBERS EFFECTIVELY
Carers and family members may be less willing to enable the individual to take risks than healthcare
professionals because they feel a continued sense of protection of their loved one, even when they
are adults. Due to this, the importance of involving them in the risk management process cannot be
underestimated and there are many ways in which this can be achieved, for example:
Enabling them to see what the individual is capable of rather than what they cannot
do: it can be very difficult for family members and carers to see the individual as a capable
person if they have been providing care for a long time. They will see risks as an opportunity
to cause harm rather than enhance the life of the individual. If, however, carers and family
members are enabled to see the benefits of positive risk-taking, they are more likely to be
willing to take a more constructive part in risk assessment planning.
Ensure that all information discussed during the process is clear and accessible to
them: making sure that all information is clear and fully understandable can help carers and
families see precisely what the risks and benefits of an activity might be. It may also help to
dispel inaccuracies about what risk-taking is, which may have been a factor in any reluctance
to enable the individual to take risks.
The needs and wants of carers and family members should be considered: although a
care plan is created around the individual, it is very important to let carers and family members
have their say about risk management as they will know the individual well and therefore be
aware of what their capabilities are.
Ensure that carers and family members feel valued and respected throughout the
process: anyone who does not feel as though their input is valued will be unlikely to want to
be involved in risk assessment, so it is really important that health professionals treat family
members and carers as equal partners in the risk assessment process, in line with person-
centred approaches.
When carers and family members are fully involved in a risk assessment process, this should ensure
that decisions are made that are acceptable to all, without the need for conflict between parties, which
can be difficult to resolve, and in a way that does not cause some form of distress for either the individual
or a significant other.
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RISK FACTORS THAT SHOULD BE CONSIDERED DURING RISK ASSESSMENTS
A risk factor is anything that increases the likelihood of something happening, for example a risk factor
for a heart attack is a poor diet and lack of exercise and a risk factor for depression is the experience
of bereavement.
During a risk assessment, all forms of risk factors should be discussed in order for a plan to be
created which reduces those risks as much as possible. For individuals who experience mental
illness there are several situations which increased risk factors may have, which include:
Risk of harm to self: for example, engaging in self-injurious behaviours including potential
attempts at suicide
Risk of harm to others: for example, individuals who may be at risk of losing control due to
psychosis and who may attack people who they do or do not know
Risk of being harmed by others: for example, being subject to some form of abuse
Risk of being harmed by mental health services: for example, not being given
appropriate care or being given the wrong form of medication.
The table below indicates the risk factors that may be present for each type of risk; it must be kept
in mind that some of the risk factors will be related to more than one type of risk and that ‘different
types of risk situation’ is very difficult to specify as risk is a very subjective matter and what may pose
as a risk to one person with a mental health condition may not to another and vice versa.
Potential Risk Potential Risk Factors Harm to self Family history of mental illness
A history of previous attempts of suicide or self-harming behaviour
Anxiety and agitation
Severe depression
Alcohol or drug misuse
Males are much more likely to attempt suicide than females
Chronic mental illness, particularly bipolar disorder and schizophrenia
Feelings of self-loathing and hopelessness
History of trauma or abuse
Unemployment
Social isolation
Poverty
History of involvement with the criminal justice system
Family breakdown.
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Harm to others Serious mental illness where there is a risk of psychosis
A history of abuse
Destructive relationships
Poor access to services when needed
Poor communication
Being the focus of antisocial behaviour
Experiences of prejudice and discrimination.
Being harmed by others
Specific mental illnesses, such as depression and bipolar disorder
Having access to finances, as individuals can be manipulated into giving money to people and being financially abused
Social isolation
Poor capacity to make decisions
Lack of awareness of where to seek help and support and to exercise rights
Physical dependency on others.
Being harmed by mental health services
Poor communication of needs
Being unable to access appropriate information
Lack of identification of being in crisis
Poor access to services
Improper application of the Mental Health Act 1983
Medication instructions not being properly explained
Being treated in a way that is disrespectful and undignified.
THE ROLE OF SUICIDE REDUCTION STRATEGIES
There were 6,581 suicides in the UK and Republic of Ireland in 2014. This equates to someone dying
by this method once every 90 minutes. The government has placed official suicide reduction strategies
at the forefront of mental health services because this group of individuals is at significantly increased
risk of suicide compared to the general population, although this does not mean that all individuals
who experience mental ill health will also experience suicidal thoughts or attempts.
Anyone, however, who may be considered at risk of suicide, should have reduction strategies
discussed and implemented as part of the risk assessment process. Some of these strategies
include:
Reducing prejudice about mental illness: if it appears that an individual is experiencing
prejudice or discrimination because of their mental health condition, this must be
acknowledged by the risk assessment plan, and measures put into place to reduce the harm
it has on the individual, such as offering them therapy or helping them to remove themselves
from destructive relationships where this might occur. They should also be enabled to
exercise their rights where discrimination has taken place in line with the Equality Act 2010.
Reduction of prejudice about mental illness would increase an individual’s willingness to seek
help without fear of judgement, enabling them to make a more effective recovery.
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Adequate training of health professionals to enable them to better identify someone
at risk of suicide: although some individuals will show no signs of suicidal intentions there
are some signs which can identify that they are at risk. Training for health professionals to
identify these signs may mean that interventions can be put into place to help the individual
and, should these be identified at a risk assessment, so that such individuals can be
connected to appropriate support and be monitored for changes or responses to triggers.
Proper access to care and support at a time when it is most needed such as at a time
of mental health crisis: it is vital that individuals who may show suicidal thoughts or actions
have proper care, which may have to be put into place for them because most people who
are distressed will not seek help or support on their own. Triggers for crisis must be identified
in a care plan and everyone must know what their responses and responsibilities should be
at such times, as well as ensuring that the individual themselves knows what these triggers
are.
Sufficient short- and long-term support planning: a care plan should indicate what
support measures are in place in terms of risks both in the short and long terms. Clear
identification of risks at the moment and those which can be predicted should ensure that
the individual is kept safe, but it is important to note that not all risks can be predicted, which
is why consistent review of risk management processes is vital.
Reducing access to means of suicide: it is important to know if individuals have suicide
plans or have planned such actions in the past. This way, the removal of anything which
may increase the risk of suicide, such as attempting to stockpile medication or trying to
obtain a lethal weapon, may help to reduce risks of suicide. It is important that carers and
family members are educated about those who may be in crisis and what means of suicide
might be.
Promotion of social inclusion and connectedness: supportive relationships can help
protect individuals against suicide even though there may be several risk factors.
Connectedness may be part of a care and support plan if individuals are happy to engage in,
for example, support groups or community-based activities. Although these may present
risks themselves, these must be balanced against greater risks such as social isolation,
which may increase the chance of suicide.