Managing risk: Clinical decision making in aged care mental health services

Risk assessment and management is integral to the delivery of safe,contemporary and ethical mental health care. The development of risk assessment and management is a priority for mental health services, and is an important part of clinical practice. However, the nature of this process and how health professionals understand assessment and management has been under-investigated. This paper reports on a qualitative study, undertaken at an Adelaide hospital, which investigated the risk assessment perceptions,knowledge and practices within a multi-disciplinary aged care mental health service. The research sought to identify baseline data about the clinical decision making practices of the multi-disciplinary team members, including an understanding of the issues staff face when undertaking risk assessment in both inpatient and community settings, and the barriers and enablers to effective risk assessment and management. Findings will be used to direct and support future clinical practice, training initiatives and research into risk assessment and management of people with a mental illness across all wards and services of the hospital.Fifteen staff (including medical, nursing and allied health professionals) completed a case scenario risk assessment and management plan, and participated in a semi-structured interview discussing this assessment as well as issues regarding assessment and management of risk. Data was analysed using a hybrid thematic approach. Four major themes emerged: purpose of assessment, involving issues of prevention, protection, and evaluation; the staged process of assessment and management, including information is gathering and goal establishment (including the roles of multidisciplinary staff); mastery, focusing on knowledge and skills required; and tensions in the purpose and process,specifically risk averse versus individualised care. Implications of findings, highlighting ambiguity in the process, training needs,and future directions for consumer-focused practice are discussed.