Mental Health Reference Group: Risk Management

Chapter 6 Personal Risk

54. As a consequence of illness or impairment, people with mental health problems can be more vulnerable to the variety of risks that are a part of everyday life. They can also pose an actual or perceived risk to themselves or to others. Risks vary by type and degree and are influenced by a number of variables in complex interaction. They include:

• life events or other trigger factors;
• previous life experience;
• personality;
• the effect of the mental health problems on the person's judgement and behaviour;
• how people are perceived by others in the mental health services and wider society;
• exposure to stigma, social exclusion and prejudice;
• exposure to risk associated with diagnosis, treatment, and failure of treatment;
• the attitude to risk taking of the milieu in which the person lives;
• consequences of ordinary personal choices.

55. The problem is the uncertainty of assessing from available information the likelihood that a proportion of the population will suffer certain events and, from that, calculating the odds on an individual's reaction to such events in the immediate/short-term/long-term future.

56. For instance, it has long been known that in excess of 20 risk factors leading to suicide can be identified (see table at chapter 7). Moreover, 2 or more of these being present in a person considerably increases the risk of eventual suicide.

57. Knowing they are present can inform the interview process and raise awareness for the worker or clinician. On their own they do not help to predict when a suicide attempt will take place only that the risk is higher. This may also arouse anxiety, fear - of not responding appropriately or of being blamed - and a tendency to decide on action not properly thought through.

58. Thorough assessment, informed judgement, communication to those who need to know, and a willingness to examine outcomes individually and collectively are what matters. It should never be forgotten that some individuals pose risks which may be entirely unpredictable. An organisation's practices have to be flexible and resilient enough to take all these factors into account.

59. As a consequence of their illness or impairment those with a mental health problem can be more vulnerable to the variety of risks which are a part of everyday life. They can also pose an actual or perceived risk to themselves or to others. The particular risks vary by type and degree and are influenced by a number of variables including; the effect of the mental health problem on the person's judgement and behaviour; the people they live and associate with; the environment in which they live; life events; and exposure to risk factors associated with treatment and failure of treatment. Listed below are stages of contact with helping agencies; the individuals or groups of people in relation to whom the risks may occur; a list of potential risks; and a list of actions/omissions which may increase the likelihood of the unwanted events occurring. It should also be borne in mind that the aim of risk assessment in mental health care should be to:

• determine the degree of risk arising in given circumstances;
• plan appropriate steps to reduce the risks to acceptable levels;
• communicate the assessment and care plan;
• implement the plan;
• assess, modify the plan, and let others know as often as the situation warrants;
• plan what should be done by those involved if the risk cannot be averted and with whom they should communicate.

60. All individuals and organisations providing any form of mental health service should have no difficulty in subscribing to these fundamental structures.