Social Work Practice in Mental Health by Ann Tullgren Noel Renouf Robert Bland

Author:Ann Tullgren, Noel Renouf, Robert Bland [Ann Tullgren, Noel Renouf, Robert Bland]
Language: eng
Format: epub
ISBN: 9781743314753
Barnesnoble:
Publisher: Taylor & Francis
Published: 2015-02-25T00:00:00+00:00

As with any kind of assessment, the quality of the relationship between the worker and the client is an important factor in determining the quality of the risk assessment, and the confidence that the worker can have in that assessment. It is not enough to ask the questions that lead to reassuring answers—the worker has to feel sure that the assessment is an accurate one. So, really, there are at least two assessments to be made at the same time: the degree of risk; and the degree of confidence in the assessment. A judgement also needs to be made about how changeable the situation might be and when a reassessment might need to be made, and also whether there is any associated risk to others including children, such as the risk of murder-suicide or the more common risks associated with the neglect of children.

The assessment of suicide or other risk carries with it a potential responsibility to act. Sometimes this will result in the person being admitted to a hospital or other place of safety. Often, though, it will be a case of establishing a careful plan involving the person and their family and friends: marshalling supports to maintain safety, ensuring that the person has good psychiatric treatment, reducing psychosocial stressors and building protective factors, and, importantly, planning in advance for contingencies. Every plan of this kind carries its own element of risk. For the worker, this is a heavy responsibility to be taken deliberately and carefully, on the basis of the most thorough assessment possible. Assessments and plans of this kind can prevent many suicides. So-called ‘no-harm contracts’ may be reassuring, but they are no substitute for a proper plan to manage the crisis safely, ideally in the context of a continuing relationship. Talking to a client about suicidal thoughts, and being willing to help them with a plan for managing their situation, makes it less likely that the person will kill themselves.

However, we should always be aware that it is really impossible to predict completed suicide. Ryan and Large have made the important point that it is not therefore a ‘comprehensive suicide risk assessment’ that is required for each client, but rather a comprehensive assessment of their situation and needs. Any suicidal ideas are only one part of that wider picture. As they argue, ‘This is not to say that we should abandon patient safety. Bolstering family or social support, restricting access to lethal methods of suicide or making a crisis plan are steps that should be taken for all patients in psychological crisis—not just those whom we imagine might be more likely to suicide than others’ (Ryan & Large, 2013, p. 463).

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