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NSB 204 Mental Health, Self and Others
Lecture 4 – part 2 Introduction to Risk assessment
Laura Freeburn
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Learning outcomes
• Definition of risk assessment
• Essential factors to complete a risk assessment
• The process of risk assessment
• Risk areas for mental health
• When to do a risk assessment
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Definitions
• Risk – the likelihood of behaviour that may be beneficial or harmful to oneself or others
• Risk factors – the particular features of illness, behaviour or circumstances that lead to an increased risk
• Risk assessment – the process of determining the potential beneficial or harmful consequences to a person/others of an event
• Risk management – planning to minimise harmful behaviour and maximise beneficial behaviour
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Why do we do risk assessments?
• Risk is inherent with any health care concern
• e.g. falls, pressure injury, aspiration
• Duty of care for the nurse to identify potential risk and implement strategies to mitigate risk
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Mental health risk areas
• Vulnerability
• Absence without approval
• Suicide/ self harm
• Aggression
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Essentials of risk assessment
• Therapeutic relationship
• Respectful and collaborative process
• Focus on safety
• Recovery focused approach
• Recognise and build on people’s strengths
• Approach is consistent with trauma informed care
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A cyclical process
Identification or re- vis iting of the
potential for risk
Conducting a comprehensive risk
assessment
Careful consideration of all risk factors
Summaris ing and developing a risk prevention and
management plan
Implementation of well-informed interventions
Evaluating the success of those
actions
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Process of risk assessment
Use of clinical judgement
Use of standarised scales
Inclusion of MDT, individuals and their
caregivers
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When do we do risk assessments?
• When presenting to services
• Pre/post leave (if an inpatient)
• When medically reviewed
• Significant life events
• Fluctuations in mental state
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Information collected in risk assessment
• Static factors
• Dynamic factors
• Future factors
• Protective factors
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Static vs dynamic vs future factors
Static
• Factors that aren’t likely to change
• Often historical but can also be current or longitudinal
• E.g. past life events, chronic conditions or permanent disability
Dynamic
• Recent or ongoing events
• Likely to be altered with intervention
• Usually current but can be longitudinal
• E.g. Current stressors, social support, substance use, impulsivity
Future
• Events or circumstances which are likely to occur and impact on risk
• E.g. recurrence of previous stressors or triggers, anniversary of notable dates, major life transitions, pending court dates
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Protective factors
• Protective factors mitigate risk factors
• Focused on enhancing wellbeing
• E.g. employment, study, support networks, future focus
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Important!
• Risk fluctuates over time and in response to changing circumstances
• Risk needs to be reassessed regularly
• Risk assessment does not 100% accurately predict risk, but rather is a prediction or current circumstances
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Risk assessment example
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Summary
• An ongoing process
• Risk assessments cannot predict the future or eradicate risk entirely
• Uses a process to understand potential likelihood of risk
• Therapeutic alliance and collaboration with other is essential to increased accuracy
• Protective factors will form the basis of risk management
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References
• Ayhan, F., & Üstün, B. (2021). Examination of risk assessment tools developed to evaluate risks in mental health areas: A systematic review. Nursing forum, 56(2), 330–340. https://doi.org/10.1111/nuf.12557
• Callaghan, P. & Grundy, A. (2017). Violence risk assessment and management in mental health: a conceptual, empirical and practice critique. The Journal of Mental Health Training, Education and Practice. 13. 10.1108/JMHTEP-04-2017- 0027
• Queensland health (2019). Violence risk assessment and management framework- mental health services . Violence risk assessment and management framework, mental health, alcohol and other drug services
