Development of risk assessment in Lanarkshire Dr Robert Gibb Iain Mackenzie NHS Lanarkshire 7 th August 2012

Agencies involved Mental Health and other health care systems Social Work Voluntary sector Police Scottish Prison Service – HMP Shotts & HMP Addiewell Housing Other support agencies e.g. LAMH, Penumbra, Heatherpark House team

Legislation Mental Health (Care and Treatment) (Scotland) 2003 Criminal Procedure (Scotland) Act 1995 as amended by MHCT 2003 Act Multi Agency Public Protection Arrangements Care Programme Approach Memorandum of Procedure Adult Support and Protection (Scotland) Act 2007 Adults with Incapacity Act

Risk assessment Enshrined in the Mental Health (Care and Treatment) (Scotland) Act 2003 STDC & Compulsory Treatment Order That if the patient were not provided with such medical treatment there would be a significant risk-(i) to the health, safety or welfare of the patient; or (ii) to the safety of any other person;

Risk assessment - principles Enshrined in Criminal Procedure (Scotland) Act 1995 CORO – “Civil risk criterion” plus Restriction Order – it appears to the court that (a) having regard to the nature of the offence with which the person is charged; (b) the antecedents of the person; and (c) the risk that as a result of their mental disorder the person would commit offences if set at large,..

Risk Assessment - Principles …. that it is necessary for the protection of the public from serious harm so to do, the court may, subject to the provisions of section 59, further order that the person shall be subject to the special restrictions set out in Part 10 of the 2003 Act, without limit of time.

Risk Assessment - Principles Serious Harm Test – as a result of the person's mental disorder, it is necessary, in order to protect any other person from serious harm, for the patient to be detained in hospital, whether or not for medical treatment (“Serious risk to others criterion");

Social Services Codes of Practice Employers responsibilities 2.1 “Implementing and monitoring written policies on: ……. risk assessment…..” Workers responsibilities 4.1 Recognising that service users have the right to take risks and helping them to identify and manage potential and actual risks to themselves and others”

Social Services Codes of Practice 4.2 “Following risk assessment policies and procedures to assess whether the behaviour of service users presents a risk of harm to themselves or others” 4.3 “Taking necessary steps to minimise risks of service users from doing actual or potential harm to themselves or other people”

Social Services Codes of Practice 4.4 “Ensuring that relevant colleagues and agencies are informed about the outcomes and implications of risk assessments”

Risk assessment policy Developed February 2011 Level 1 – Risk screen Level 2 – Structured Professional Judgement Don’t use Actuarial tools Meetings chaired by Psychiatrist or Psychologist Minimum completion of 12 monthly

NHS/RMA What tools in Lanarkshire? HCR-20 (Webster et al 1997) RSVP (Hart et al 2003) SARA (Kropp et al 2000) SAM (Kropp et al 2007) B Safer (Kropp et al2007)

Risk Assessment - NHS Training delivered by Dr Robert Gibb and Dr Fiona Mair to mental health professionals Forensic community team all trained in HCR-20 Forensic inpatient team – large number of staff trained in HCR-20 Dr Mair and Dr Gibb also trained in RSVP, SARA, B- Safer, SAM Other Consultant Forensic Psychiatrists and Clinical Psychologist trained in risk tools Other teams in Lanarkshire also trained in HCR-20

NHS Lanarkshire – Risk assessment Some staff trained in PCL-R Fewer trained in IPDE Dr R. Gibb certified trainer in Risk Assessment – accredited by the Risk Management Authority Forensic team not able to provide risk assessments across NHS Lanarkshire

Social work resources What tools? Level of Service Care Management Inventory (LSCMI) Risk Matrix 2000 (Thornton et al 2000) Stable and Acute (SA07) (Harris and Hanson 2007)

Developments Need agreement on what risk assessment tools should be employed Need joint assessments to take place and avoid duplication of effort Joint training for health, social work and other agencies in the area of risk assessment and management

MAPPA MAPPA In Lanarkshire October 2011 Level 1 – 317 Level 2 – 99 Level 3 - 0

Care Programme Approach “Structured process for the management of risk and the care and treatment planning in a manner which is patient focused and consistent with the principles of recovery.” All forensic patients with more than one professional involved subject to CPA or Criminal Justice review in Lanarkshire Meetings 3 – 6 monthly

CPA meetings Pre-CPA meeting CPA meeting Close liaison with MAPPA to avoid duplication In Lanarkshire, preference has been to use CPA to manage cases.

Adult Support and Protection (Scotland) Act 2007 Investigating Officer Assessment, Banning, Removal, Protection Orders Adult Protection Committee ? Value with well supported vulnerable mental health patients ? Value of these in Forensic Ward

Peer Review Peer review process Restricted patient audit Risk review group Risk review/audit in response to ‘A question of Balance’