Mental Health Nursing
Mental Health Nursing
Mental Health Nursing
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
154 Acute <strong>Mental</strong> <strong>Health</strong> <strong>Nursing</strong><br />
under supervision by somebody who is trained in their use (e.g., clinical<br />
psychologist, clinical nurse specialist).<br />
The debate as to whether the clinical, ‘subjective’, or actuarial, ‘objective’,<br />
approach is most relevant to clinical practice is complex. The reality<br />
of clinical practice is that tests and scales can help to inform clinical<br />
judgement, not replace it as ultimately people make decisions, not tests.<br />
There is evidence to suggest that a combination of the clinical and actuarial<br />
approach is warranted to structure clinicians’ risk judgements, as this<br />
may be superior to unaided clinical judgement (McNiel and Binder, 1994;<br />
Borum, 1996; Douglas et al., 1999). The Structured Clinical Judgement<br />
Approach, as described by Hart (1998), attempts to bridge the gap<br />
between the scientific (actuarial) approach and the clinical practice of risk<br />
assessment. This approach emphasises the need to take account of past<br />
history, objective measures, current presentation, context/environment and<br />
protective factors, and recognises the reality that the process of clinical<br />
risk assessment is a dynamic and continuous process which is mediated<br />
by changing conditions (see Dolan and Doyle, 2000; Doyle, 2000).<br />
Ultimately the method used by the mental health nurse to elicit information<br />
and assess risk will depend upon the circumstances where the<br />
assessment is being carried out, interdisciplinary arrangements, the time<br />
constraints involved and the wishes of the person being assessed.<br />
Managing violence risk<br />
The management of risk to others encompasses clinical, health and<br />
safety, and public protection (political) issues has to be balanced with the<br />
rights of the individual. Indeed, this forms one of the most vociferous<br />
debates concerning the radical changes introduced in the proposed reforms<br />
to the <strong>Mental</strong> <strong>Health</strong> Act (DoH, 2000b) where individuals suffering from<br />
a dangerous severe personality disorder who are considered to be a risk<br />
to others can be admitted for compulsory treatment. Effective risk assessment<br />
should therefore be part of risk management, and vice versa, and as<br />
behaviour likely to cause harm to others may be symptomatic of many<br />
disorders, it is unlikely to be susceptible to any single intervention.<br />
Closely examining the factors which have contributed to past violent<br />
behaviour should prove fruitful in identifying targets for treatment which<br />
may reduce risk. For example, poor anger control – anger management;<br />
substance abuse – drug/alcohol therapy; persecutory delusions – cognitive<br />
and pharmacological interventions. In summarising the approaches<br />
to managing violence risk, Harris and Rice (1997) distinguish between<br />
several types of risk management intervention which take account of<br />
both security and therapeutic interventions. These include interventions<br />
that are as follows.