Open Forum: how staff training and risk assessments can play their part in limiting violence and anger among people mental health problems

Mental health services are under increasing pressure to predict and prevent violent incidents being perpetrated by mental health service users. The Mental Health Bill will certainly place mental health workers under growing pressure to balance complicated risk judgements.

Mental health training institutions frequently extol the importance of positive risk-taking in effective care, especially given a backdrop of research showing that the public is more likely to be at risk of stranger violence from drug and alcohol users than from people with mental health problems. However, the increasing legal emphasis and fear of litigation has distanced the patient from being at the heart of care provision.

Risk is inherent in mental health practice, and service users are likely to engage in behaviour that poses risks to themselves or others. Risk assessment is based on degrees of judgement, detailed assessment and information gathering. It is more effective when the mental health professional has a detailed knowledge of the service user and considers all the risk factors and relevant history.

Often this corroborated information about risks is poorly communicated between agencies, and sometimes it eludes mental health staff. This makes me wonder how often practitioners resort to multi-information sources when assessing risk and co-ordinating care. Defensible practice demands this thoroughness in assessment and management processes.

If staff numbers were sufficient and training in risk assessment regular, studies suggest the rate of homicides and suicides by mental health patients would fall further.

The National Confidential Inquiry recommends training every three years for mental health staff as a minimum, but I suspect the public would not be reassured by this standard. This may reinforce negative attitudes to mental health professionals and service users when incidents occur that may not have been predictable or the fault of clinical staff.

Steve Jones is an academic at Edge Hill University

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