Risk systems: identifying the key components and interdependencies of a mental health system in which risk decisions are made
R. Nathan, S. Jones, A. BrownIntroduction
A consensus has yet to be reached on whether the appraisal of risk is best represented quantitatively (e.g. probability estimates) or qualitatively (e.g. formulation). A more fundamental issue, though, is how to use the agreed representation to inform practice so as to reduce the likelihood of harm. The real-world implementation of risk representations in clinical practice is dependent on how these representations inform clinical decision-making. Clinical decision-making takes place in a complex system of interacting agents, entities, and processes. To date, risk-related research and practice guidance has not paid sufficient attention to studying this system.
Objectives
To develop a standardised model for representing those complex mental health systems in which appraisals of ‘risk of harm to others’ are used.
Methods
In order to identify a generally applicable representation of the system, practice experts in the field of risk of harm to others reflexively examined the systems within which they worked to firstly identify the actual individual agents, entities and processes in their systems. A thematic review of the elements was then undertaken so as the inform the development of more generally applicable characterisation of the system for wider use.
Results
The generalisable characterisation of the system (with illustrative local examples in parenthesis) is presented in Figure 1.
Image 1: Long description.