Assessment of risk and staff safety

NHS Forth Valley mental health emergencies
NHS Forth Valley

Risk assessment must be done before the psychiatric emergency is seen in person. Risks may include:

  • Risk the individual might pose to themselves e.g. through self harm, suicide, self neglect.
  • Risk the individual might pose to others e.g. through violence, neglect of those in their care.
  • Risk the individual may be exposed to from others e.g. through violence, exploitation, neglect, reprisals.

The risk assessment should include information from as many sources as possible, including:

  • Crisis management plans
  • Police charges / vulnerable persons reports
  • Social work vulnerable persons reports
  • Child protection concerns
  • Collateral history from concerned carers
  • Advanced Statements
  • Verbal updates from front line staff such as carers / support workers
  • Past history of violence, weapon carrying or violence when detained under the Mental Health Act
  • Past history of alcohol and substance misuse (this has been estimated to double the risk of violence in those with mental health issues)

All professionals have a duty to share relevant information with colleagues from other agencies when not to do so may lead to harm to the patient, or to staff.

Where to carry out the assessment

  • The place of assessment and necessary staffing will be informed by the initial risk assessment.
  • Where there is a history of significant violence, weapon carrying or aggression when a patient has previously been detained under The Act, attempts should be made to assess the patient in a safe environment such as an interview room in a GP surgery or a Mental Health Resource Centre.
  • Police should be asked to assist if there is a perceived risk of violence.
  • N.B. Police have no powers to remove a person from their home under The Act: if a decision is made to take the patient elsewhere for an assessment, the patient must be detained by medical staff and police could then assist to prevent violence.

 

Gaining entry to the patient's home

  • If a patient refuses to allow access to their property, the MHO can apply to the local courts for a warrant, which grants Police powers to force entry.
  • For a warrant to be issued the doctor and MHO must provide sufficient evidence that there is reasonable grounds to believe the individual is mentally unwell, that there are significant risks associated with the situation and that all reasonable steps have been made to engage with the individual.
  • If the initial risk assessment concludes that Police support and a safe environment is not required professionals can proceed with the assessment of a patient in their own home.
  • Individuals presenting with a Psychiatric Emergency should not be seen by a lone professional in their own home. At least two professionals should be present.

Staff safety from aggression

All staff who are likely to perform assessments on individuals presenting with a Psychiatric Emergency should be trained in the management of violence and aggression.

Staff should be aware of risk in the patients home:

  • If lone working, lone working procedures for the organisation must be followed.
  • Be aware of potential weapons.
  • Staff should position themselves with a clear escape route.
  • Staff should have a telephone to summon assistance.
  • If a potential weapon is present the patient should be asked to remove it.
  • If the patient refuses to remove the weapon, staff should leave immediately and call for police assistance.
  • In case of escalation and aggression, staff should leave immediately and call for police assistance.
  • Teams should be aware of the situation and have an agreed timescale to raise the alarm if staff do not return from the assessment/make contact within the agreed time frame.

Editorial Information

Last reviewed: 28/05/2021

Author(s): Julia Ferrari, Joe McGhee, Duncan Westall, William McFadden, Heather Tainsh , Susan Sutherland, Marie White , Anne Cook, Justin McNicholl, Douglas Armstrong, Dr Nabila Muzaffar, Dr Stuart Affleck, Dr David Cumming, Andrew Angus, Jackie Maher, Rose Mills, Vincent Hughes..