Recommendation 1: Information Sharing

The message that needs to be underlined is that in all circumstances where there is benefit to the service user in sharing information with other agencies, such as the police, third sector agencies and probation, then all reasonable efforts should be made to obtain the consent of the service user to do so. In the circumstances where the service user withholds consent, or obtaining consent is not possible, the healthcare team must then consider the risk to the service user and the wider public of not sharing the information. The issues considered and the output of this consideration must be documented in the service user’s clinical record and risk management plan.

Recommendation 2: Information Sharing and the police national computer (PNC)

The PNC does have the facility to record core information about service users about whom the mental health services have significant concerns if they go ‘absent without leave’, or fall out of contact with the services. Furthermore, the PNC can accommodate instructions on what actions to take, and who to contact, should the service user be stopped by the police in ‘identified circumstances’ and a check made against their identity. A service user does not have to have any previous criminal record for this facility to be utilised.

Recommendation 3: Occupational Therapists and medicines management   

A care coordinator, regardless of his/her professional background, does need to have at least a basic understanding of the medicines their clients are on and the usual dose range of these.

Recommendation 4: Client Focused Risk Management Training and Risk Assessment

Two issues need to be addressed in client-focused risk assessment training delivered in all mental health trusts and in documented risk assessment.

The first is the concept of ‘risk vulnerability’, a concept that was not well understood by all members of the MHSU’s care team. Furthermore it does not appear to be routinely included in risk assessment training. In the case of the MHSU, situational stress increased the patient’s risk vulnerability but was not a ‘relapse indicator’ per se. The lack of appreciation of this concept did adversely affect the risk management plan agreed within his care team.

The second is staff’s awareness of the risks posed by service users engaged in sports such as karate, kick boxing, boxing, kung fu etc. When individuals become competent in any of these sports their hands and feet are considered to be dangerous weapons. For some of these sports such as kick boxing, it does not take long for some degree of competency to be achieved as this case highlights. It is essential that mental health professionals’ awareness of this is enhanced, as it has real implications with the process of risk assessment especially where service users are prone to relapse and hit out with their hands and feet.