Risk Assessment in Mental Health Nursing

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This essay discusses the importance of risk assessment in mental health nursing and explores the tools used for assessing suicide and self-harm risks among patients. It emphasizes the need for a safe care environment and suggests ways to improve the effectiveness of risk assessment tools.

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Running head: RISK ASSESSMENT IN MENTAL HEALTH NURSING
Risk Assessment in Mental Health Nursing
Name of the Student
Name of the University
Author Note

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1RISK ASSESSMENT IN MENTAL HEALTH NURSING
In the care process of mental health patients, it is very crucial to minimize risks
related to the care process and it is the duty of all mental health care provider to provide a
safe care environment to the patients with mental health problems. According to the study of
Runeson et al. (2017), it is reported that, in recent times, incidents of risks in among the
mental health patients are enhancing day by day. So, it can be said that, the management of
risks in the mental health care settings is one of the primary duty of the mental health care
professionals. On the other hand, the study of Ottisova et al. (2016), showed that, the risks
of violence is one of the most common problems among the mental health patients and in
addition to this, the prevalence of violence incidents are quite common among the mental
health patients. Therefore, suicide behaviour is another risks which is closely associated with
the mental health patients. So, it can be said that, the application of risk assessment plan is
required to mitigate the risks present in the mental health care settings. In this essay, different
type of risk assessments in acute mental health care patients, effectiveness of the risk
assessment tools, and a few ways of improving the risk assessment process are described in
a brief manner.
In the mental health care scenario, one of the most common risks of mental health
patients is risk of self-harm and risk of suicide. According to the study of Singhal et al.
(2014), self-harm is one of the major risks of mental health patients and this is also an
important reason of hospital admission of mental health patients. In addition to this, it is also
evident that, the mental health patients who harms themselves are also associated with the
risks of suicide. It is reported that the chances of self-harm is most common among the
patients who are suffering from alcohol misuse, anxiety, depression. In this study, it was
reported that there is positive correlation in between the psychiatric illness and incidents of
self-harm. The study result found that, all type of mental illness or psychiatric disorders are
associated with the risks of suicide in the mental health care settings. In this study various
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2RISK ASSESSMENT IN MENTAL HEALTH NURSING
type of mental health problems such as bipolar disorder, depression, alcohol abuse, anxiety
disorders, schizophrenia, eating disorders and substance abuse were assessed and all type of
mental health disorders had very high amount of rate ratios (RR). In addition to this, this
study also examined the correlation of self-harm and suicide behaviour of the patients with
physical illness and the RRs were lower than that of the mental health patients. Therefore the
study of Bolton et al. (2015), also suggested that, the risks of suicide is very common among
the mental health patients. The study reported that, suicide is 15th most common reason of
death in world and the rate is higher among the mental health patients while comparing with
the general population. The care provider of the mental health patients have to asses and
manage the risks of suicide among the mental health patients. In order to asses the risks of
suicide among the mental health patients, various tools can be used. Not only the high rate
of death, but high economic burden is also associated with the risks of suicide among the
people with mental health patients. The study of Bolton et al. (2015) reported that, total direct
and indirect costs of suicide in US is almost $41bn in US in a year. Moreover, it is reported
that, the chances of committing suicide is very high during the first few month after the
diagnosis of mental health disorders. Although, it is assumed that, the risk of suicide is
lowered in the impatient department of hospital, but it is not always true that the suicide rate
is low in the hospital inpatient departments. In US, every year almost 5 patient per 1000 beds
occupied committed suicide in the inpatient hospital department. In a meta-analysis study,
suggested that, the cases of suicides mostly took place during the early period of hospital
admission. It was reported that, by using the risk assessment tools, the chances of suicides
can be reduced (Ottisova et al., 2016). So, from the study of previous literature, it is evident
that, in the acute mental health care settings, risk assessments of self-harm risks and suicide
risks are necessary to conduct.
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3RISK ASSESSMENT IN MENTAL HEALTH NURSING
For assessing the risks of suicide among the mental health patients, the Beck
hopelessness scale (BHS) is widely used and it is assumed that, BHS is one of the most
successful prediction tools. On the contrary, various studies also reported that, the specificity
of this Beck hopelessness scale (BHS) is comparatively low while predicting the chances of
suicide and self-harm among patients of mental health. In a meta-analysis study, it was
reported that, the similar results were found in case of 4 suicide studies and 6 self-harm
studies out of total 10 studies used in this meta-analysis. In this study, it was found that, BHS
had a a specificity of 42% and a sensitivity of 78-80% ( Singhal et al., 2014). The study of
Aloba, Esan and Alimi (2017) investigated the effectiveness of BHS among the
schizophrenia patients of Nigeria who were at the high risk of suicide. In this study, almost
211 patients completed the BHs along with sociodemographic questionnaire. In the study, the
participants were interviewed by using suicidality module of the Mini International
Neuropsychiatric Interview (MINI) so that validity of the BHS can be examined. This study
result showed that, the shortened BHS score had the highest sensitivity of 100% along with a
specificity of 83.2%. On the other hand, at this cut-off score, on the 4-item BHS, the NPV
and PPVB were 100% and 85.6% respectively along with an accuracy rate of 91.6%. In
another study by Aloba et al. (2017), the validity of the BHS was investigated among the
student nurses. The study result showed that, the BHS had reliable satisfactory scores and its
validity was supported significant correlation values.
In assessing suicidal risks among the mental health patients, another tool that is
Patient Health Questionnaire-9 ( PHQ-9) is used and it is a subjective and quick reporting
scales and the information of this scales can be incorporated in the medical records of the
patients. According to study of Moritz et al. (2016), the use of Patient Health
Questionaire-9 (PHQ-9) is very common among the nursing care providers who are
associated with the care process of the mental health care patients. In this study, it was also

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4RISK ASSESSMENT IN MENTAL HEALTH NURSING
reported that, for assessing the risks of the mental health patients, a newly devised
Maladaptive and Adaptive Coping Styles Scale (MAX) was administered to mental health
patients. Among the total patients 75 patients had problem of psychosis, 100 people had issue
of depression and in the control group almost 1100 people were recruited. However, the
study result showed that this newly adaptive scale is not so effective in assessing the risks of
suicide. Therefore the study of Rajapakse et al. (2014), reported that, the use of PHQ-9
scale is quite effective in addressing the suicide behaviour among the male and female
patients of Sri Lanka. In this study, it was reported that, the use of PHQ-9 showed significant
positive result in assessing suicide issues in Sri Lanka, Moreover, this study also reported
that, for addressing the suicidal ideation, another scale was used and that was Pierce Suicide
Intent Scale (PSIS). This is interviewer administered tool that is used for assessing the
suicidal behaviour among the patients in Sri Lanka. In addition to this study of Breet,
Bantjes, and Lewis (2018), also supported the use of Pierce Suicide Intent Scale (PSIS)
among the patients of mental health in order to assess the risks. However in this study, the
authors used this Pierce Suicide Intent Scale (PSIS) to assess the self-harm behaviour among
the patients. In this study 238 patients with reported incidents of self-harm was recruited in
this study and it is reported that most of the patients were in a depressed condition during the
incidents of self-harm. In this study, a 12 item PSIS scale was used to asses the self-harm
behaviour of the patients. The scale had a score range of 0 to 25 where scores between 0 to 3
indicates a low suicidal intent, scores between 4 to 11 indicates a moderate intent of suicide
and score of more than 11 indicates a severe suicide intent among the patients. The study
result showed that, this scale was quite effective in addressing the issue of suicide intent
among the patients with mental health problems (Breet, Bantjes, and Lewis, 2018). In
addition to this study, result also reported that, among the mental health patients, substance
use was also associated with the suicidal behaviour among the mental health patients. This
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5RISK ASSESSMENT IN MENTAL HEALTH NURSING
study concluded that, substance use is one of the most crucial modifiable risk factors of
suicide intent among the mental health patients. Another common suicide prevention tools
among the mental health patients is APSI and it is used in Ireland for assessing the issue of
suicide among those patients. By using this model mental health care providers provide a
stepped care therapies to the patients with mild to moderate mental health problems. This
model provides a integrated approach of suicide prevention among the mental health patients
and it can be said that, the APSI may work to reduce the suicide cases among the patients
with mental health problems (Kelly, Sammon, & Byrne, 2014). According to the study of
Weber et al. (2017) reported the use of Columbia Suicide Severity Rating Scale (C-SSRS) in
the suicide prevention process among the mental health patients. In studies, it is reported
that, this Columbia Suicide Severity Rating Scale (C-SSRS) had a sensitivity of 67%,
positive predictive value of 14%, specifically of 76% and negative predictive values of 98%.
The study of Bolton et al. (2015) also supported the study of Weber et al. (2017) as they also
reported about the effectiveness of this scale. In this study it was also reported that, the
Newer suicide risk scales predicted future suicide behaviour with specificity and sensitivity
of 76% and 67% respectively.
In order to improve the current risk management system for the mental health
patients, the knowledge regarding those risk assessment tools should be enhanced so that the
care providers can easily the manage the risks of self-harm or suicide among the patients. As
a part of this, the care providers may improve their communication skills as it is very useful
have a good communication among the care providers and the patients. Along with this, the
training process should be initiated for the participants so that they can have adequate
knowledge regarding the risk management tools. In various studies, it is reported that, the
mental health care providers have lack of knowledge in managing such conditions and it can
be said that, the improvement of knowledge among the care providers will improve the
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6RISK ASSESSMENT IN MENTAL HEALTH NURSING
effectiveness of risk assessment tools in the mental health care settings ( Smith et al., 2014).
It is also reported that, the effectiveness of risk management tools or strategies is dependent
on the involvement of staffs in the whole process and as a part of this, the staffs of mental
health care settings should be involved directly or indirectly to gain the best outcome from
those risk assessment tools (Health Services Executive, 2019).
Hence, it can be concluded that, the use of risk assessment tools is very common
among the mental health care settings as they are more prone to commit suicide and self-
harm behaviour is also very common among the mental health patients. So, it is very crucial
for the care providers to maintain a safe care environment for the patients. For assessing the
risks, various tools are used in the mental health care setting. However, their effectiveness
can be improved as well.

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7RISK ASSESSMENT IN MENTAL HEALTH NURSING
References
Aloba, O., Esan, O., & Alimi, T. (2018). Adaptation of the Beck Hopelessness Scale as a
suicide risk screening tool among Nigerian patients with schizophrenia. International
journal of psychiatry in clinical practice, 22(1), 19-24.
Aloba, O., Olabisi, O., Ajao, O., & Aloba, T. (2017). The Beck Hopelessness Scale: Factor
structure, validity, and reliability in a non-clinical sample of student nurses in South-
western Nigeria. Journal of Behavioral Health. Retrieved from-
https://www.ejmanager.com/mnstemps/57/57-1468670175.pdf?t=1558695236
Bolton, J.,M., Gunnell., D., & Turecki., G. (2015). Suicide risk assessment and intervention
in people with mental illness. BMJ, 351:h4978.
Breet, E., Bantjes, J., & Lewis, I. (2018). Substance use and self-harm: a cross-sectional
study of the prevalence, correlates and patterns of medical service utilisation among
patients admitted to a South African hospital. BMC health services research, 18(1), 157.
Health Services Executive (2019). Risk Management in Mental Health Services. Health
Services Executive. Retrieved from-
https://www.hse.ie/eng/services/publications/mentalhealth/riskmanagementinmentalhealt
h.pdf
Kelly, J., Sammon, N., & Byrne, M. (2014). APSI: A proposed integrative model for suicide
prevention. Irish journal of psychological medicine, 31(3), 203-212.
Moritz, S., Lüdtke, T., Westermann, S., Hermeneit, J., Watroba, J., & Lincoln, T. M. (2016).
Dysfunctional coping with stress in psychosis. An investigation with the Maladaptive and
Adaptive Coping Styles (MAX) questionnaire. Schizophrenia research, 175(1-3), 129-
135.
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8RISK ASSESSMENT IN MENTAL HEALTH NURSING
Ottisova, L., Hemmings, S., Howard, L. M., Zimmerman, C., & Oram, S. (2016). Prevalence
and risk of violence and the mental, physical and sexual health problems associated with
human trafficking: an updated systematic review. Epidemiology and psychiatric
sciences, 25(4), 317-341.
Rajapakse, T., Griffiths, K. M., Christensen, H., & Cotton, S. (2014). A comparison of non-
fatal self-poisoning among males and females, in Sri Lanka. BMC psychiatry, 14(1), 221.
Runeson, B., Odeberg, J., Pettersson, A., Edbom, T., Adamsson, I. J., & Waern, M. (2017).
Instruments for the assessment of suicide risk: a systematic review evaluating the
certainty of the evidence. PLoS one, 12(7), e0180292.
Singhal, A., Ross, J., Seminog, O., Hawton, K., & Goldacre, M. J. (2014). Risk of self-harm
and suicide in people with specific psychiatric and physical disorders: comparisons
between disorders using English national record linkage. Journal of the Royal Society of
Medicine, 107(5), 194-204.
Smith, A. R., Silva, C., Covington, D. W., & Joiner Jr, T. E. (2014). An assessment of
suicide-related knowledge and skills among health professionals. Health
Psychology, 33(2), 110.
Weber, A. N., Michail, M., Thompson, A., & Fiedorowicz, J. G. (2017). Psychiatric
emergencies: assessing and managing suicidal ideation. Medical Clinics, 101(3), 553-
571.
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