Head To Head Maudsley Debate

Does the emphasis on risk in psychiatry serve the interests of patients or the public? Yes

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f902 (Published 12 February 2013) Cite this as: BMJ 2013;346:f902

Re: Does the emphasis on risk in psychiatry serve the interests of patients or the public? Yes

The debate, I believe, focuses on what can be an unhelpful use, in general, of the application of risk assessment. That is, whether risk is high, medium or low for whatever category of risk we are measuring (suicide, homicide, neglect, falls etc).

Risk assessment is part of the wider gathering of information with the patient and others about the problems they have and the context they occur in. This should in turn lead to the development of a shared meaningful plan to help address the key factors that are jointly considered contributing most significantly. That is what we may call a treatment/management/care plan. My opinion is that this is also the same as the risk management plan for the vast majority of cases seen in clinical practise.

Dr Morgan does, I acknowledge, allude to this in his references stating that risk assessment needs to be better integrated with clinical assessment. I have ran suicide risk management training sessions for several years to clinical teams and virtually everybody still thinks of a care/treatment plan as distinctly separate from a risk plan. Although this thinking is contributed to significantly by organisations creating the (tick box) risk assessment platforms; which sit separate from the rest of the assessment rather than embedded within.

Equally of importance for risk assessment, and sometimes forgotten, is understanding how much the care/risk plan (if I may be permitted to call it this) is judged likely to moderate the risk(s). Our clinical skills to help construct such as a plan, with the person, may be of equal importance to the final 'calculation' of the risk someone possesses. Hopefully, people leave consultations with a plan that simultaneously helps address the problems the person attended with and the risks (and risk factors) highlighted within.

Competing interests: Previously chair of SHA Patient Safety: Suicide Prevention

17 February 2013
Keith R Linsley
consultant psychiatrist
Tees Esk and Wear Valleys NHS Foundation Trust
chester le street health centre DH33UR