scholarly journals Collaborative risk assessment in secure and forensic mental health settings in the UK

2020 ◽  
Vol 33 (5) ◽  
pp. e100291
Author(s):  
Sarah Markham
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Decision Making ◽  
Health Policy ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Forensic Mental Health ◽  
Mental Health Settings ◽  
The Uk ◽  
Risk Assessment And Management

Collaborative risk assessment and management have been recommended in health policy for over a decade. We consider the nature and need for collaborative risk assessment and management between patients and clinicians in secure and forensic mental health settings in the context of shared decision making and personalised care in the UK. We examine the extent to which policy and recent initiatives have influenced the embedding of such practice in services through consideration of the evidence provided by research and the Commissioning for Quality and Innovation framework, and conclude that there is a need for further improvement.

scholarly journals Attitudes towards shared decision making in mental health: a qualitative synthesis

2017 ◽  
Vol 22 (3) ◽  
pp. 233-256 ◽  
Author(s):  
Emma Kaminskiy ◽  
Simon Senner ◽  
Johannes Hamann
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Shared Decision Making ◽  
Service User ◽  
Service Users ◽  
Shared Decision ◽  
Qualitative Synthesis ◽  
Content Type ◽  
Mental Health Settings ◽  
Word Search

Purpose Shared decision making (SDM) prioritises joint deliberation between practitioner and service user, and a respect for service-users’ experiential knowledge, values and preferences. The purpose of this paper is to review the existing literature pertaining to key stakeholders’ attitudes towards SDM in mental health. It examines whether perceived barriers and facilitators differ by group (e.g. service user, psychiatrist, nurse and social worker) and includes views of what facilitates and hinders the process for service users and practitioners. Design/methodology/approach This review adopts the principles of a qualitative research synthesis. A key word search of research published between 1990 and 2016 was undertaken. Qualitative, quantitative and mixed methods studies were included. Findings In total, 43 papers were included and several themes identified for service user and practitioner perspectives. Both practitioners and service users see SDM as an ethical imperative, and both groups highlight the need to be flexible in implementing SDM, suggesting it is context dependent. A range of challenges and barriers are presented by both practitioners and service users reflecting complex contextual and cultural features within which interactions in mental health take place. There were qualitative differences in what service users and practitioners describe as preventing or enabling SDM. The differences highlighted point towards different challenges and priorities in SDM for service users and practitioners. Originality/value The presentation of nuanced views and attitudes that practitioners and service users hold represent an important and under reported area and offer insight into the reasons for the gap between idealised policy and actual practice of SDM in mental health settings.

scholarly journals The Montgomery ruling, individual values and shared decision-making in psychiatry

2018 ◽  
Vol 24 (2) ◽  
pp. 93-100 ◽  
Author(s):  
Julian C. Hughes ◽  
David Crepaz-Keay ◽  
Charlotte Emmett ◽  
K. W. M. Fulford
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Shared Decision Making ◽  
Learning Objectives ◽  
Evidence Based ◽  
List Type ◽  
Shared Decision ◽  
Individual Values ◽  
The Uk

SUMMARYThis article starts with a brief review of the UK Supreme Court's decision in the Montgomery case. Although much of the focus in discussing the case has been on the disclosure of risk, an important aspect of the model of consent contained in the judgment is that of dialogue. The model of informed consent set out in Montgomery suggests shared decision-making as the norm. Central to shared decision-making, however, is an awareness of values and of how values can vary between people. We introduce values-based practice as an approach that is entirely in keeping with the precepts of the Montgomery judgment. We go on to review how values-based practice and shared decision-making are relevant to psychiatric practice, using as examples recovery practice and compulsory detention under the Mental Health Act 1983.LEARNING OBJECTIVES•Appreciate that a new test of consent has been established as of a result of the UK Supreme Court's Montgomery ruling•Learn about the role of values-based practice as a partner to evidence-based practice in implementing Montgomery•Understand how values-based practice and Montgomery together support shared decision-making in psychiatryDECLARATION OF INTERESTNone.

scholarly journals Mental health professionals’ perceived barriers and enablers to shared decision-making in risk assessment and risk management: a qualitative systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nafiso Ahmed ◽  
Sally Barlow ◽  
Lisa Reynolds ◽  
Nicholas Drey ◽  
Fareha Begum ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Decision Making ◽  
Risk Management ◽  
Shared Decision Making ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Perceived Barriers ◽  
Shared Decision ◽  
Barriers And Enablers

Abstract Background Risk assessment and risk management are fundamental processes in the delivery of safe and effective mental health care, yet studies have shown that service users are often not directly involved or are unaware that an assessment has taken place. Shared decision-making in mental health systems is supported by research and advocated in policy. This systematic review (PROSPERO: CRD42016050457) aimed to explore the perceived barriers and enablers to implementing shared decision-making in risk assessment and risk management from mental health professionals’ perspectives. Methods PRISMA guidelines were followed in the conduct and reporting of this review. Medline, CINAHL, EMBASE, PsycINFO, AMED and Internurse were systematically searched from inception to December 2019. Data were mapped directly into the Theoretical Domains Framework (TDF), a psychological framework that includes 14 domains relevant to behaviour change. Thematic synthesis was used to identify potential barriers and enablers within each domain. Data were then matched to the three components of the COM-B model: Capability, Opportunity, and Motivation. Results Twenty studies met the eligibility criteria. The findings of this review indicate that shared decision-making is not a concept commonly used in mental health services when exploring processes of risk assessment and risk management. The key barriers identified were ‘power and best interest’ (social influences) and ‘my professional role and responsibility’ (social/professional role and identity). Key enablers were ‘therapeutic relationship’ (social influences) and ‘value collaboration’ (reinforcement). The salient barriers, enablers and linked TDF domains matched COM-B components ‘opportunity’ and ‘motivation’. Conclusion The review highlights the need for further empirical research to better understand current practice and mental health professionals’ experiences and attitudes towards shared decision-making in risk assessment and risk management.

scholarly journals Probability and loss: two sides of the risk assessment coin

2011 ◽  
Vol 35 (11) ◽  
pp. 413-418 ◽  
Author(s):  
Matthew M. Large ◽  
Olav B. Nielssen
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Other ◽  
Current Form ◽  
Mental Health Settings ◽  
Future Harm ◽  
Two Sides

SummaryRisk assessment has been widely adopted in mental health settings in the hope of preventing harms such as violence to others and suicide. However, risk assessment in its current form is mainly concerned with the probability of adverse events, and does not address the other component of risk – the extent of the resulting loss. Although assessments of the probability of future harm based on actuarial instruments are generally more accurate than the categorisations made by clinicians, actuarial instruments are of little assistance in clinical decision-making because there is no instrument that can estimate the probability of all the harms associated with mental illness, or estimate the extent of the resulting losses. The inability of instruments to distinguish between the risk of common but less serious harms and comparatively rare catastrophic events is a particular limitation of the value of risk categorisations. We should admit that our ability to assess risk is severely limited, and make clinical decisions in a similar way to those in other areas of medicine – by informed consideration of the potential consequences of treatment and non-treatment.

scholarly journals A feasibility trial of Power Up: A smartphone app to support patient activation and shared decision making for mental health in young people (Preprint)

2018 ◽  
Author(s):  
Julian Edbrooke-Childs ◽  
Chloe Edridge ◽  
Phoebe Averill ◽  
Louise Delane ◽  
Michael P Craven ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Young People ◽  
Shared Decision Making ◽  
Randomized Control Trial ◽  
Patient Activation ◽  
Shared Decision ◽  
Cluster Randomized Control Trial ◽  
Randomized Control ◽  
Cluster Randomized

BACKGROUND Digital tools have the potential to support patient activation and shared decision making in the face of increasing levels of mental health problems in young people. There is a need for feasibility trials of digital interventions to determine the usage and acceptability of interventions. In addition, there is a need to determine the ability to recruit and retain research participants to plan rigorous effectiveness trials and therefore, develop evidence-based recommendations for practice. OBJECTIVE To determine the feasibility of undertaking a cluster randomized control trial to test the effectiveness of a smartphone app, Power Up, co-designed with young people to support patient activation and shared decision making for mental health. METHODS Overall, 270 young people were screened for participation and 53% (N = 142) were recruited and completed baseline measures across eight specialist child mental health services (n = 62, mean (SD) age = 14.66 (1.99) years, 52% female) and two mainstream secondary schools (n = 80; mean (SD) age = 16.88 (0.68) years, 46% female). Young people received Power Up in addition to management as usual or received management as usual only. Post-trial interviews were conducted with 11 young people from the intervention arms (specialist services n = 6; schools n = 5). RESULTS Usage data showed that there were an estimated 50 (out of 64) users of Power Up in the intervention arms. Findings from the interviews indicated that young people found Power Up to be acceptable. Young people reported: 1) their motivation for use of Power Up, 2) the impact of use, and 3) barriers to use. Out of the 142 recruited participants, 45% (64/142) completed follow up measures, and the approaches to increase retention agreed by the steering group are discussed. CONCLUSIONS The findings of the present research indicate that the app is acceptable and it is feasible to examine the effectiveness of Power Up in a prospective cluster randomized control trial. CLINICALTRIAL ISRCTN: ISRCTN77194423, ClinicalTrials.gov NCT02552797

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