Development of risk assessment in Lanarkshire

Dr Robert GibbIain Mackenzie

NHS Lanarkshire 7th August 2012

Agencies involved• Mental Health and other health care systems• Social Work• Voluntary sector• Police• Scottish Prison Service – HMP Shotts & HMP

Addiewell• Housing• Other support agencies e.g. LAMH, Penumbra,

Heatherpark House team

Legislation

• Mental Health (Care and Treatment) (Scotland) 2003• Criminal Procedure (Scotland) Act 1995 as amended

by MHCT 2003 Act• Multi Agency Public Protection Arrangements• Care Programme Approach • Memorandum of Procedure• Adult Support and Protection (Scotland) Act 2007• Adults with Incapacity Act

Risk assessment

Enshrined in the Mental Health (Care and Treatment) (Scotland) Act 2003

• STDC & Compulsory Treatment Order• That if the patient were not provided with

such medical treatment there would be a significant risk-(i) to the health, safety or welfare of the patient; or (ii) to the safety of any other person;

Risk assessment - principles

Enshrined in Criminal Procedure (Scotland) Act 1995

• CORO – “Civil risk criterion” plus• Restriction Order – it appears to the court that

(a) having regard to the nature of the offence with which the person is charged; (b) the antecedents of the person; and (c) the risk that as a result of their mental disorder the person would commit offences if set at large,..

Risk Assessment - Principles

…. that it is necessary for the protection of the public from serious harm so to do, the court may, subject to the provisions of section 59, further order that the person shall be subject to the special restrictions set out in Part 10 of the 2003 Act, without limit of time.

Risk Assessment - Principles

• Serious Harm Test – as a result of the person's mental disorder, it is necessary, in order to protect any other person from serious harm, for the patient to be detained in hospital, whether or not for medical treatment (“Serious risk to others criterion");

Social Services Codes of Practice

Employers responsibilities• 2.1 “Implementing and monitoring written

policies on: ……. risk assessment…..”Workers responsibilities• 4.1 Recognising that service users have the

right to take risks and helping them to identify and manage potential and actual risks to themselves and others”

Social Services Codes of Practice

• 4.2 “Following risk assessment policies and procedures to assess whether the behaviour of service users presents a risk of harm to themselves or others”

• 4.3 “Taking necessary steps to minimise risks of service users from doing actual or potential harm to themselves or other people”

Social Services Codes of Practice

• 4.4 “Ensuring that relevant colleagues and agencies are informed about the outcomes and implications of risk assessments”

Risk assessment policy

• Developed February 2011• Level 1 – Risk screen• Level 2 – Structured Professional Judgement• Don’t use Actuarial tools• Meetings chaired by Psychiatrist or

Psychologist• Minimum completion of 12 monthly

NHS/RMA

• What tools in Lanarkshire?• HCR-20 (Webster et al 1997)• RSVP (Hart et al 2003)• SARA (Kropp et al 2000)• SAM (Kropp et al 2007)• B Safer (Kropp et al2007)

Risk Assessment - NHS

• Training delivered by Dr Robert Gibb and Dr Fiona Mair to mental health professionals

• Forensic community team all trained in HCR-20• Forensic inpatient team – large number of staff

trained in HCR-20• Dr Mair and Dr Gibb also trained in RSVP, SARA, B-

Safer, SAM• Other Consultant Forensic Psychiatrists and Clinical

Psychologist trained in risk tools• Other teams in Lanarkshire also trained in HCR-20

NHS Lanarkshire – Risk assessment

• Some staff trained in PCL-R• Fewer trained in IPDE• Dr R. Gibb certified trainer in Risk Assessment

– accredited by the Risk Management Authority

• Forensic team not able to provide risk assessments across NHS Lanarkshire

Social work resources

What tools?• Level of Service Care Management

Inventory (LSCMI)• Risk Matrix 2000 (Thornton et al 2000)• Stable and Acute (SA07) (Harris and

Hanson 2007)

Developments

• Need agreement on what risk assessment tools should be employed

• Need joint assessments to take place and avoid duplication of effort

• Joint training for health, social work and other agencies in the area of risk assessment and management

MAPPA

• MAPPA In Lanarkshire October 2011• Level 1 – 317• Level 2 – 99• Level 3 - 0

Care Programme Approach

• “Structured process for the management of risk and the care and treatment planning in a manner which is patient focused and consistent with the principles of recovery.”

• All forensic patients with more than one professional involved subject to CPA or Criminal Justice review in Lanarkshire

• Meetings 3 – 6 monthly

CPA meetings

• Pre-CPA meeting• CPA meeting• Close liaison with MAPPA to avoid duplication• In Lanarkshire, preference has been to use

CPA to manage cases.

Adult Support and Protection (Scotland) Act 2007

• Investigating Officer• Assessment, Banning, Removal, Protection

Orders• Adult Protection Committee• ? Value with well supported vulnerable

mental health patients• ? Value of these in Forensic Ward

Peer Review

• Peer review process• Restricted patient audit• Risk review group• Risk review/audit in response to ‘A question of

Balance’