Risk Assessment Research Health And Social Care Essay

guess Assessment Research Health And Social Care try out adventure of exposure mind of the potential of emphasis to self or differents has been recognized as a core element of clinical practice in psychiatric forensic community and private clinical environgenial settings (Stedman et al., (2000). Risk sound judgement increases the ability to understand an individuals potential for uncivilized behaviour, assists the individual to reposition and for organisations to better allocate throttle resources to more in effect(p) treatment course of instructions (Snowden et al., 2009).thither is a significant correlation between substance horror, psychiatric disorders, non-compliance with music and the likelihood of aggressive behaviour amongst those with significant mental illness (Daffern et al., 2002). The affiliate between medication noncompliance, power and the effect medication noncompliance has on the over use of intoxicant and other substances pauperizations to be int erpreted into account in conducting a happen sound judgment (Swartz et al., 1998). Daffern (2002), prevaillights the need for clinicians to be aware of the link between aggressive behaviours, the influence other environments and face-to-face interactions outside of the hospital situation discombobulate on the uncomplaining and the need to make up this into account when ontogeny any jeopardyiness appraisal plan. in that location needs to be considerable care taken in developing a danger solicitude plan to ensure that the plan does non focus on control and moves away from the primary goal of management (Heilbrun, 1997).Case Study Risk Assessment Plan crowd presents with triad main issues that need to be focused on in the lay on the line sound judgement plan. jam has ongoing symptoms that would fall out to indicate schizophrenia, alone a more detailed assessment go out need to be conducted. pile has issues related to his aggressive behaviour towards others when he feels overwhelmed by his delusion schizophrenia symptoms. The first indicator of these symptoms was when he was 21 and believed he was being watched by cameras at his place of work. throng reports that this delusional belief resulted in crowd together assaulting a co worker and that police were involved and he was incidental hospitalised. crowd together reports twice assaulting his father when he believed his father was in his head. The James likewise reports a autobiography of using illicit drugs since his early teens at high school. James reports that his marijuana use has been regular since early teens and he has on occasions misused prescription drug Valium. In adulthood, James reports use of beer and vodka has gone from weekend binge drinking to regular quartette to five days a week of clayey use of beer and spirits. James also reports his tobacco use has been regular since early teens and has increased to heavy use of 30 cigarettes a day over the last 12 months. This last 12-month period also is reported by James as a period where he has increased significantly his abuse of alcohol and marijuana. From James intro during the interview, it would be reasonable to assume that he is minimising he aim of substance use. Another issue that influences James symptoms and behaviours is the noncompliance with plus medication, which needs to be addressed in the overall periliness assessment plan (Swartz et al., 1998).AggressionAntonius et al. (2010), highlights the value of adventure assessment as a valuable tool to assist the clinician to predict and prevent future violence and to improve afoot(predicate) treatment and management protocols. Howells (1996), postulates that it is not possible to guide all risks of violence by forensic mental health patients, but therapeutic programs can be effective in changing ruby behaviours. Although James direct of violence would appear, from his self-report, to be on the downcaster level of violence, there ap pears to be in recent clock time a grit within James that he is becoming overwhelmed in the last 12months. This is indicated by not still what he says but also his use of substances, alcohol and tobacco usage has increased significantly in the last 12 months.. The potential for committing acts that are more flushed can also be assumed to be increasing. Snowden et al. (2009), give that the interrogatory with the Classification of Violence Risk (COVR) showed good validity when attempting to assess the risk of violence amongst patients with a autobiography of violence and mental health issues. However, Snowden (2009), also warns that the COVR test requires information from patient files as well as patient self-report, and test results may be affected by the patient who minimises their history or violence, and the lack of inlet to the patients file. In this case, James presents as guarded in his answers to many questions and distinctly only wanted to be out of the hospital, h ence there would be a high probability of James minimising his level of violent behaviour. The mark that the police were still outside would give an indicator that they may have more knowledge of James past level of violence. Doing a clinical interview to assess the level of risk without the patients file, as was occurring in this instance, would appear unwise and places the interview into a clinical interview format with low predictor validity (Steadman et al., 2000). The quality of the information that the person conducting the risk assessment has access to, will determine the effectiveness of the risk assessment unconscious process (Heilbrun, 1997).Actuarial risk assessments have been found to be significantly more valid in predicting violence than unstructured clinical interviews (Steadman et al.,2000). Hilton et al., (2001), argues that risk assessment of disordered offenders with a history of violence requires the use of actuarial assessment tools to enable a valid indicator in relation to risk to self or others. Howells (1996), argues the benefits of ensure risk management plans requires the individual to attend to some form of anger management program, to assist the individual to correspond more functional strategies for dealing with their current frustrations.Buchanan (2008), highlights the need for those conducting a risk assessment to be aware of the casual tie-up between mental disorder and violence. There needs to be more information obtained other than the basic demographic information of age, race, gender and relationship status, which should include family environment, history of victimisation of knob, how a client spends their day all of which have been found to correlate with mental illness and violence (Buchanan, 2008).Substance Abuse and Non-compliance with musicSwartz et al., (1998), found in their study that a combination of substance abuse history and a history of non-compliance with medication, either recent or persistent term, was found to have a significant association with violent behaviour. Swartz et al. (1998), also made the observation of a correlation between an individual with limited personal insight combined with poor rationality of their illness and affair of medication. This non-compliance with medication may not be deliberate behaviour by the individual as non-compliance and substance abuse may be inversely reinforcing which results in self-medicating with alcohol and substances. James would appear to have been self-medicating for many geezerhood with a self-reported significant increase in approximately the last 12 months. James reports the misuse of prescription medication Valium at sundry(a) times. James would appear to view medication as only effective if it gives an immediate reaction and would need to have medication education as part of formulating an effective risk assessment/risk management plan. either risk management plan for James would also need to turn back a community ba sed specialised out patient program focused on treating dually diagnosed mental illness clients (Swartz et al., 1988). Research shows a high level of co morbidity between those suffering from a mental illness such as schizophrenia and substance abuse and violent behaviour (Daffern et al., 2002).Mental IllnessAlthough James has admitted to no serious violent acts, his history of symptoms of schizophrenia with delusions elements would have to taken as a archetype of potential risk to self or others. James reports that, in the last 12 months he has been finding it increasing difficult to cope. James presents as not having insight into his mental illness, and not wanting to be submissive in any medical treatment. Taylor (1998), found in her research that of the 309 pile with psychosis who had killed, the large majority (75%) were deluded at the time of their offence (p49). Patient presentation must be observed carefully when assessing risk of violence aside from the obvivious feature s of psychosis that may be present, but also delusions may produce symptoms of apprehension or depression and delusions can indicate the patients inability to make or maintain relationships and history of violence (Taylor, 1998). James states during his interview that his illness had caused a break up of a past relationship and as a result had not been in a relationship for 3 geezerhood when he had to move back to live with his parents.Rogers (2000), makes mention of the need to take into account when conducting a risk assessment not only the risk factors but the protecting(prenominal) factors, which are factors that may reduce maladaptive behaviours on the individual. In the case of James, he appears to have a closer connection to his mother than he does with his father. However, his mother would seem to be very static and his fathers more dominate. James mother may well have a significant impact on James being more illness with medication, if her assistance was integrated in to a risk management plan. Her participation in the management plan may well assist James to catch ones breath compliant with medication and assist in harm minimisation strategies in relation to alcohol and tobacco use by James. Swartz et al., (1988), also cognizant to be aware when doing a risk assessment on a patient exhibiting non compliance with medication and substance abuse that the patient may have some underlying personality traits that may need testing for.James does not present as a affright to himself and reports no past history of self-harming behaviours and denies any current thought of self-harming ideation. However, James current file is not available to the interviewer and it would be unwise to accept James own statement as to his current mental state. James presents as depressed, agitated, reactive and extremely frustrated which would require the potential of self-harm to be incorporated for monitoring in any risk assessment, peculiarly if he is unploughed in h ospital for further psychiatric assessment. Douglas et al., (2009), reports that suicide/self-harm is a risk factor when the patient has a history of schizophrenia, violence and substance abuse. terminal observation of James during the interview shows that he would go into a rocking apparent movement on numerous occasions, did not maintain good eye link with the interviewer and indicated a number of times his level of frustration about the time he had waited and not liking hospitals. The probability would be that James would be kept in the psychiatric ward of the hospital for 72 hours to dispense with for a complete psychiatric assessment to ascertain his level of threat to himself or his father. Often people with the current presentation, clinical history and violence of James have a higher potential to assault others especially family members, which further tends to alienate them from their remaining family support (Douglas et al., 2009).ConclusionRogers (2000) warns that risk only evaluations are inherently inaccurate (p598), which may have consequences on the client by labelling the client as violent. We must also work towards a standardised definition of risk assessment. The New Zealand Mental Health care (1998) defines risk assessment as a risk to the progression of symptoms of the illness, risk of the individual intentionally self-harming, the risk of self-harm that was not done intentionally and the risk of causing harm to others either by intent or as a result of risk taking behaviours. Crowe (2003), raises the issue of the need for a more specific defining of risk in the context of risk assessment and risk management.The debate in between health professionals as to whether clinical or actuarial assessment provides a higher level or risk assessment and hence reduces the risk of harm to others as well as the patient continues to be debated. Doyle et al., (2002), reports that although actuarial assessments is shown as statistically superior to unstr uctured risk assessment techniques, actuarial assessment focuses on static factors and misses dynamic factors such as treatment non-compliance, family dynamics, poor caprice control and substance abuse. Rogers (2000), reports that parents who are more accepting and hence understanding of the patients mental illness has been found to be a strong protective factor to assist the patient.There appears to be a need for further research to develop a more integrated memory access to risk assessment to ensure a more standardised process is implemented. The risk management of violent behaviours is a complex process and requires a multidisciplinary approach that needs to focus on social, psychological and medical aspects of the individual (Howells, 1996). In the case of James, any risk management program must be approached from the broader perspective to achieve beneficial for James in the long term. Hilton et al., (2001), suggests that as demand for more valid risk assessment outcomes incr ease in relation to forensic mental health patients that actuarial assessment will be incorporated as an important part of the risk assessment process.