Title: Improving Risk Management in Mental Health Services
Funder: Department of Health (England)

Abstract: The overall aim of the programme is to improve the quality of clinical risk management of a small minority of individuals with mental disorder who are identified as a high-risk of harm to the public. Public protection from violent, sexual, and other high-risk behaviours is increasingly expected from healthcare professionals. These problems place a considerable burden of care on healthcare services and some specialist mental health services are specifically intended to reduce risk. However, DoH policy has not translated widely into clinical practice. Risk assessment and risk management are key methods used by professionals. Risk is highest in community settings where it is most difficult to manage. New risk management interventions are required with a community focus. Research methods and statistical procedures have been developed to provide clinical tools to help healthcare professionals in risk management. Our programme will build on these developments and our team has specialist expertise in the field of risk assessment and risk management research and a proven track record to develop the new instruments for use in clinical practice. These methods have not been previously applied to UK populations. Our previous research has quantified the risks of violence at the population level resulting from psychiatric morbidity. We shall shift our emphasis to lifestyle factors in this area of epidemiological research and identify high-risk subgroups, the associated burden of care, and appropriate public health interventions. We have previously identified cohorts with mental disorder within high-risk populations, which we shall further study in the programme, and on which we shall develop three risk assessment instruments. We shall achieve our aims and objectives through 3 interlinked projects: Project 1. Two national cross-sectional surveys (i) National Survey of Health and Wellbeing (ii) Men’s Health and Modern Lifestyles Project 2. Development of 3 “new generation” static and dynamic risk assessment instruments. Statistical modelling of available datasets: (i) Incidence cases of psychosis (ii) Patients discharged from Medium Security (iii) Released prisoners with severe personality disorder Project 3. Validation of new instruments for use with: (i) Patients discharged from General Services (severe mental illness) (ii) Patients discharged from Medium Security (severe mental illness) (iii) Released prisoners (severe personality disorder) Outputs: (i) Reports providing information for policy-makers on service needs for high-risk individuals and the epidemiology of high-risk behaviours, including the size of the problem, associated factors, and public health interventions indicated by the findings. (ii) Three risk assessment instruments to be used by healthcare professionals in Adult General, Forensic Mental Health, and DSPD services when providing aftercare. (iii) Report providing information for healthcare professionals, including managers, on current practice in risk assessment and risk management in NHS Trusts, examples of good practice, and areas for improvement.


Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;7.3 MANAGEMENT AND DECISION MAKING
Health categories: MENTAL HEALTH