National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK.
National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK.
Lancet Psychiatry. 2020 Dec;7(12):1046-1053. doi: 10.1016/S2215-0366(20)30381-3. Epub 2020 Nov 12.
Risk assessments are a central component of mental health care. Few national studies have been done in the UK on risk assessment tools used in mental health services. We aimed to examine which suicide risk assessment tools are in use in the UK; establish the views of clinicians, carers, and service users on the use of these tools; and identify how risk assessment tools have been used with mental health patients before suicide.
We did a mixed-methods study involving three components: collection and content analysis of risk assessment tools used by UK mental health services; an online survey of clinicians, service-users, and carers; and qualitative telephone interviews with clinicians on their use of risk assessment tools before a suicide death and their views of these tools. The online survey was advertised through the National Confidential Inquiry into Suicide and Safety in Mental Health's (NCISH) website and social media, and it included both quantitative and open-ended qualitative questions, and respondents were recruited through convenience sampling. For the telephone interviews, we examined the NCISH database to identify clinicians who had been responsible for the care of a patient who died by suicide and who had been viewed as being at low or no immediate risk of suicide.
We obtained 156 risk assessment tools from all 85 National Health Service mental health organisations in the UK, and 85 (one per each organisation) were included in the analysis. We found little consistency in use of these instruments, with 33 (39%) of 85 organisations using locally developed tools. Most tools aimed to predict self-harm or suicidal behaviour (84 [99%] of 85), and scores were used to determine management decisions (80 [94%]). Clinicians described positive aspects of risk tools (facilitating communication and enhancing therapeutic relationships) but also expressed negative views (inadequate training in the use of tools and their time-consuming nature). Both patients and carers reported some positive views, but also emphasised little involvement during risk assessment, and a lack of clarity on what to do in a crisis.
Assessment processes need to be consistent across mental health services and include adequate training on how to assess, formulate, and manage suicide risk. An emphasis on patient and carer involvement is needed. In line with national guidance, risk assessment should not be seen as a way to predict future behaviour and should not be used as a means of allocating treatment. Management plans should be personalised and collaboratively developed with patients and their families and carers.
The Healthcare Quality Improvement Partnership.
风险评估是精神卫生保健的核心组成部分。在英国，针对精神卫生服务中使用的风险评估工具进行的全国性研究较少。我们旨在研究在英国使用的自杀风险评估工具；了解临床医生、护理人员和服务使用者对这些工具使用的看法；并确定在自杀前这些风险评估工具是如何用于精神卫生患者的。
我们进行了一项混合方法研究，包括三个部分：收集和分析英国精神卫生服务机构使用的风险评估工具；对临床医生、服务使用者和护理人员进行在线调查；对临床医生进行定性电话访谈，了解他们在自杀死亡前使用风险评估工具的情况以及对这些工具的看法。在线调查通过国家精神卫生保密自杀和安全调查（NCISH）的网站和社交媒体进行宣传，包括定量和开放式定性问题，通过方便抽样招募受访者。对于电话访谈，我们检查了 NCISH 数据库，以确定负责照顾自杀患者的临床医生，并且他们被认为自杀风险较低或没有立即自杀风险。
我们从英国所有 85 家国民保健服务精神卫生机构获得了 156 种风险评估工具，其中 85 种（每家机构一种）纳入了分析。我们发现这些工具的使用一致性很小，有 33 种（39%）的机构使用了本地开发的工具。大多数工具旨在预测自残或自杀行为（85 种中的 84 种，占 99%），并根据评分来确定管理决策（80 种，占 94%）。临床医生描述了风险工具的积极方面（促进沟通和增强治疗关系），但也表达了消极观点（在使用工具和工具耗时方面的培训不足）。患者和护理人员都报告了一些积极的观点，但也强调在风险评估中参与度较低，以及在危机中缺乏明确的应对措施。
评估过程需要在精神卫生服务中保持一致，并包括如何评估、制定和管理自杀风险的充分培训。需要强调患者和护理人员的参与。根据国家指导，风险评估不应被视为预测未来行为的一种方式，也不应被用作分配治疗的一种手段。管理计划应个性化，并与患者及其家人和护理人员共同制定。
医疗保健质量改进伙伴关系。
