5th International Conference on Mental Health and Human Resilience (Barcelona 7-8 March 2019)

The 5th International Conference on Mental Health and Human Resilienceis held in Barcelona. Use the following link to check out background information on the conference:

https://documentcloud.adobe.com/link/track?uri=urn%3Aaaid%3Ascds%3AUS%3A276d9684-0df8-44de-b758-141ae5830221

The following link provides the outline programme for the two-day conference. I present 'Implementing Positive Risk-Taking in Practice' as one of the keynotes on Day 2:

https://documentcloud.adobe.com/link/track?uri=urn%3Aaaid%3Ascds%3AUS%3Aadcbb3e5-8a54-469e-9035-3f2e27ef8076

Paris Conference Presentation 2018

The following was the abstract I submitted for the keynote presentation at the recent Mental Health Congress in Paris (9-11/7/18):

Positive Risk-Taking: From Rhetoric to Reality

Do we pay enough attention to the impact that the language we use has on the people we serve, and the ways in which we serve them? Our adherence to professional jargon more often serves to exclude and/or confuse other people. This is most notable in the language of risk, particularly where the negative connotations can often drive a blame culture and promote an unnecessary risk averse approach. Where is the person within such a picture?

Assessing and manging risk is an essential skill; but, so to is calculated and reasoned risk-taking. My concept of ‘Positive Risk-Taking’, initiated in 1994, brings the language of risk, strengths and person-centred outcomes together in a clear and sharp focus. As a concept, it is underpinned by the principles and practice of good risk assessment and management, applicable to all facets of mental health, wider health, and social care considerations.

The concept is focused on the outcomes, rather than solely being led by the risks. Taking risks for positive outcomesrequires a clear definition and description; but, it is also underpinned by the fully recognized components of mental health good practice… focused and contextualized risk assessment is counter-balanced by a full strengths assessment; supervision and support is complemented by teamwork and team-focused training. Collective decision-making enables balanced and reasoned risk-taking decisions to be made with confidence, and the identification of individual responsibilities for action to be outlined within a thoughtful plan.

Welcoming the audience to the presentation:

A partial link to what you missed!

https://drive.google.com/open?id=1Nmes1fRYvhkBTSLw0rXk8w7yuoxKdTkN

Fielding a question or two:

https://drive.google.com/open?id=1pytmlqXLHoxJc8KKu20wZOT49xjpaKoa

And sharing in the post presentation accolades (holiday snapshots time !!):

Risk Decision-Making

How many times have you been asked 'where is the risk assessment?' knowing that the quality of the work is of secondary value at best. A new manual has been produced in 2013 to focus the attention of people at all levels of organisations involved in health and social care services. We all make risk decisions, but we occasionally need guidance to support our confidence in doing so. This manual is focused on reducing bureaucracy, promoting quality, and responding to what we should really mean when we talk of being person-centred in our work.

Risk Decision-Making is available from Pavilion Publishing.

Inadequate risk assessment

A Foundation Trust (along with a care home provider) has recently received a heavy fine for inadequate risk assessment when placing a man at the care home; he subsequently killed one and seriously injured another care home worker. The degree of tragedy should not be underestimated, but you can instantly feel the bureaucratic knees jerking across the managerial universe. Larger tick-box forms will be required in greater frequencies so we can all rest assured 'this will never happen again', or so the political rhetoric goes!

I don't know the full details of the case, but I do know these are extremely rare incidents that should not be allowed to cloud over the vast majority of good decisions and good practice that does happen across our stretched public bodies. However, there is a wider case to be answered in the quality of information being communicated when a person with complex issues is required to be placed out of the health care system into the social care system. There is a 'tip of an iceberg' effect happening here, but it is not one that is going to trigger a rash of homicides. What I observe in my travels around the care and support landscape is a wholly inadequate approach to referrals, mostly driven by fear of the commissioning and managerial stick that drives the pursuit of numbers and throughput.

The result is often one of referral being a process of withholding relevant information (particularly risk information) for fear that it will be used to refuse the placement. Practitioners are under pressure to get people moved on, not to find the most suitable place for their continuing progress and support. Even when risk information is passed on, it is more frequently in the format of the dreaded tick-box exercise that communicates little of any use or relevance for planning appropriate support.

For me this case does raise the issue of poor examples of practice, but I would like the starting point for addressing the issue to be one that investigates the crazy 'system' we have evolved, whereby staff are under constant pressures from the bureaucracy that completely undermine any chance of delivering good and safe practice. If you want to develop a system that thrives on good practice it has to be a bottom-up approach; if you want a system that demonstrates what schizophrenia actually is then use the top-down managerial approach of 'talking the talk while actively disabling the walk'.

Risk Definitions

Risk:

is the likelihood of an event happening with potentially harmful or beneficial outcomes for self and others. (Possible behaviours include suicide, self-harm, neglect, aggression and violence; with an additional range of other positive or negative service user experiences).

Risk Assessment:

is the gathering of information through processes of communication, investigation, observation and persistence; and analysis of the potential outcomes of identified behaviours. Identifying specific risk factors of relevance to an individual, and the circumstances in which they may occur. This process requires linking the context of historical information to current circumstances, to anticipate possible future change.

Risk Management:

is the statement of plans and the allocation of responsibilities for translating collective decisions into real actions. It is the activity of exercising a duty of care where risks (positive and negative) are identified. It entails a broad range of responses linked closely to the wider process of care planning. The activities may involve preventative, responsive and supportive measures to diminish the potential negative consequences of risk and to promote potential benefits of taking appropriate risks. These will occasionally involve more restrictive measures and crisis responses where the identified risks have an increased potential for harmful outcomes. It should also clearly identify the dates for reviewing the assessment and the management plans.

Positive Risk-Taking:

[From: Morgan, 2004]: is weighing up the potential benefits and harms of exercising one choice of action over another. Identifying the potential risks involved, and developing plans and actions that reflect the positive potentials and stated priorities of the service user. It involves using available resources and support to achieve the desired outcomes, and to minimise the potential harmful outcomes. It requires an agreement of the goals to be achieved, or a clear explanation of any differences of opinion regarding the goals or courses of action.

Morgan, S. (2004) Positive risk-taking: an idea whose time has come. Health Care Risk Report 10 (10) 18-19.

Morgan, S. (2007) Working with Risk Practitioner’s Manual. Brighton: Pavilion Publishing.