Risk Assessment Flashcards
What is risk assessment?
- Mental health risk assessment (MHRA) is the process of assessing the possible risk factors of a persons mental health problems on themselves or others.
- Is an essential skill of all mental health nurses
- Mental health nurses continually assess risk in an acute environment.
- Although MHRA is a formally documented process, because risk is dynamic, and is therefore a constant process.
Why assess risk?
- Identify and predict dynamic risk indicators
- Develop risk management plans where the objective is to reduce and manage the presence of risk.
- Monitor changes or improvements to risk levels
- May inform treatment or intensity of interventions
- Provides a standardised and legal form of documentation.
- Informally, good risk assessment can help us to recognise triggers and changes to risk levels and de-escalate or manage these risks, minimising their impact on the person and others.
When is MHRA conducted?
- During admission
- In the course of taking history
- If there is any change in clinical presentation
- On discharge or transfer
- Informally: Constantly!
Principles of risk assessment
- Risk is normal
- Risk cannot be eliminated, only minimised
- Risk is dynamic
- Identifying a risk = a duty to manage that risk
- The management of risk should be collaborative with the person and others
- MHRA should involve the collection of information from multiple sources
Types of risk?
- Self harm and suicide
- Harm to others
- Risk of exploitation
- Neglect
- Risk to reputation during acute illness
- Issues with compliance or absconding
- Falls
- Physical risks such as adverse effects of medication, obesity etc.
- Substance use, addictions
- Social risks such as homelessness, lack of supports and resources, isolation
Static or dynamic?
- Static: Gender, history, ethnicity…anything that’s generally fixed and in the past, or pertaining to the persons current situation but which cannot be changed.
For example: a persons history of previous self harm is a static risk factor that can give a baseline for assessment.
- Dynamic: Anything that might come along and change the current levels of risk.
Things like anniversaries, unwanted visitors or phone calls to a person on a ward are important to triggers identify.
Suicide in Australia
- In 2019, there were 3318 recorded suicide deaths.
- Suicide is the leading cause of death among people aged 15–44
- Over ¾ of suicide deaths (75%) are male
- Indigenous Australians are twice as likely to die by suicide
- The most common suicide method in Australia is by hanging, strangulation or suffocation (63% m, 49% f), followed by poisoning (29% f, 8.2% m)
- Australia has some of the highest recorded suicide rates in the world.
Higher suicide risk factors
- Male
- Indigenous
- Single
- Unemployed
- Broken relationship
- Prison
- Mental Illness
- Substance misuse
- Professionals with access to means (Farmers, Dentists, Vets)
- Poor physical and social health
Performing the assessment
Should we ask people if they’re suicidal?
Yes…all evidence suggests that if we ask the person, they are likely to give us an indication of their thoughts and ideas around suicide. This suicidal ideation, can indicate that we need to consider intent.
What’s the level of Intent?
The likelihood of the person acting on ideation…or intending to act. This might be measured by the presence of a plan or extreme cases, a suicide note.
How do we ask sensitive questions?
It’s not what we ask but the way that we ask it! Sometimes we just have to ask those awkward questions as sensitively as we possibly can. The art of risk assessment is not filling the form, but obtaining, interpreting and formulating the information.
Should we perform the assessment formally…with the form and a clipboard?
We should probably do this at least once in collaboration with the patient. However this shouldn’t prevent us from asking the same questions again if we feel it’s necessary.
