Mental health services can manage risk more effectively by involving service users in planning for safety, says a briefing paper published by Centre for Mental Health and the NHS Confederation’s Mental Health Network, as part of the Implementing Recovery through Organisational Change (ImROC) programme.
Risk, Safety and Recovery, by Jed Boardman and Glenn Roberts, argues that risk and safety are rightly major concerns in mental health care but that traditional methods of assessing risk have stood in the way of helping people to recover their lives. It argues that jointly produced ‘safety plans’ can be more effective ways of managing risk as well as enabling people to get on with their lives, and identifies the current lack of attention paid to the service users’ views and experience of risk and risk management.
This briefing paper examines current approaches to risk assessment and management and how these need to be changed so as to be more supportive of people’s personal recovery. In doing so it identifies a number of practical actions and supportive conditions that are necessary to support this shift towards recovery-oriented risk assessment and safety planning based on shared decision making and the joint construction of personal safety plans:
- Helping people develop their understanding, skills and confidence from supported risk taking.
- Supporting people to recognise and use their own skills, resources and resourcefulness.
- Focussing on safety planning through an emphasis on self-determination and taking responsibility for exploring options and choices.
- Enabling people to stay safe whilst supporting them taking opportunities to do the things that they value and which give their lives meaning.
- Engaging in co-production and shared responsibility for developing understanding of difficulties and co-creation of plans to develop safety and well-being.
- Having an organisational ambition to enabling people to become successfully self-directed and take control over their treatment choices and supports.
- Developing personal strategies to deal with the problems and difficulties they face.
- Having a desired outcome of people discovering a new sense of self, meaning and purpose in life, living beyond their health problems and accepting risk as part of life and living.
Risk, Safety and Recovery shows that ‘person-centred safety planning’ can bring professionals, service users and carers together to manage safety within recovery-supportive relationships. It shows that some NHS trusts have now started to change the way they manage risk and safety by updating their standards, procedures and staff training. And it calls for national leaders, provider organisations, professional bodies and practitioners to support the adoption of person-centred safety planning across the country.
Dr Jed Boardman, consultant psychiatrist at the South London and Maudsley NHS Foundation Trust and ImROC consultant, said:
“Overly defensive, risk-avoidant practice is bad practice that results in poor outcomes. Traditional risk management has been professionally dominated and focused on high-level risks, yet ignored the everyday risks that affect most people who use mental health services most of the time. This has created an imbalance that now needs to be corrected.
“Service users and practitioners all have something to gain from successful risk management and they should be able to work together when making safety plans. Making risk management as a collaborative, shared task is likely to enhance public and personal safety at the same time as giving people the chance to recover their lives on their own terms.”
Stephen Dalton, chief executive of the Mental Health Network said:
“This paper proposes a new approach to managing risk but it is one which is supported by existing national policies. This is ImROC setting the challenge to providers who must now ensure person centred safety planning becomes a reality for those using our services.”
The full briefing paper can be read here.