A new online survey of 1937 members of the Royal College of
Psychiatrists suggests that bureaucracy may be making mental
healthcare less safe.
The detailed results can be accessed by College members here:
The survey addresses the important role that psychiatrists play
in managing the risk that a small number of people with mental
health problems pose to others.
The survey found that over 90% of psychiatrists report working
in mental health services which require them to routinely complete
a form recording the risk that patients pose to other people (91%
total sample; 93% UK and Republic of Ireland).
However, 56% of psychiatrists report that they were expected to
complete forms for all their patients, regardless of whether these
patients were part of a high risk group or not (60% in UK and
Republic of Ireland).
Furthermore, 84% report that such forms had been developed
within local services for internal purposes. Critically, few of
these locally developed forms would have been tested for their
ability to identify patients who posed high levels of risk (83% in
UK and Republic of Ireland).
Whilst psychiatrists clearly perceive risk assessment as an
important clinical skill – with 83% across the total sample and
also UK/Republic of Ireland believing that a well-designed risk
assessment form could aid the application of clinical skills –
respondents report that the forms and procedures accompanying risk
assessment need to be reviewed.
86% of surveyed psychiatrists (89% in UK and Republic of
Ireland) think that existing risk assessment forms could instill a
false sense of security that risk has been assessed, with such
forms often using a ‘tick box’ approach to assessment.
58% of psychiatrists in the total sample and UK and Republic of
Ireland also report that their organisation had introduced such
forms as a ‘defensive measure’ and response to a wider cultural
context where mental health services are blamed for adverse events
involving mentally ill people, such as homicides.
Meanwhile, 82% of respondents believe that the requirement to
use risk assessment forms indicates that concern for public safety
has taken political precedence over the welfare of those suffering
from mental disorders (83% in UK and Republic of Ireland). This is
a problem because the best way to reduce risk is to provide the
highest possible standard of care.
In response to the findings, the College has launched a
multi-disciplinary review of risk assessment and management
practice chaired by Baroness Kennedy. It hopes to report interim
findings on the first stage of this work about best practice in the
management of risk to others in September.
The President of the Royal College of Psychiatrists, Professor
Sheila Hollins, said that the College will be reviewing the
educational and training needs of psychiatrists as part of
this.
Background to survey
This is the first online survey of the College membership. It is
part of a new initiative to improve dialogue, and inform action
(see: May Launch of Online Surveys).
The survey aimed to gauge members’ opinions and experiences on
assessing the risk that an individual may pose to other people.
The rationale for the survey was to inform a multi-disciplinary
review of risk assessment and management practice launched by the
College in June. Chaired by Baroness Kennedy, this group hopes to
report interim findings about best practice in the management of
risk to others in September.
Methodology
The survey was comprised of 18 questions.
The survey focused on structured risk assessment. This was
defined as “using a form (paper or computerised) to record the
presence of absence of risk factors (often using tick boxes)”.
An invitation to participate in the survey was sent to the 9168
College members in the UK, Republic of Ireland, and overseas with a
working email address. These constitute 71% of the total College
membership (n=12976). 1937 College members completed the survey
(21%).
The rationale for (i) not employing a random sample and (ii)
only inviting those with email address was three-fold.
Firstly, the survey aimed to alert the membership to the launch
of the new online survey initiative – it had an awareness raising
objective.
Secondly, the survey wanted to seek members’ views on which
issues a current College working group on risk management and
assessment (chaired by Baroness Kennedy) should address – it had a
consultative objective.
Thirdly, the College wanted to gauge the feasibility of running
online surveys and mechanisms for dialogue, particularly where
resources and time for a postal survey component were not
available.
As a non-probability sample with a sampling bias towards members
with email addresses, the results are not statistically
representative of the wider College membership.
However, the results provide important insights into the views
and opinions of a comparatively large sample of the College
membership. The composition of the sample is also broadly
reflective of the membership types and geographical spread of the
membership.
Further details
Chris Fitch
College Research Fellow,
cfitch@cru.rcpsych.ac.uk