Assessing and Managing Risk in Social Work Practice - Essay Example

Assessing and Managing Risk in Social Work Practice Introduction What do people know about risk in mental health services? Like any other community members, people reflect about risks to the population; as professionals, people reflect on the risk that they face in their line of work, and of the danger to the individuals with mental illness which social workers are at risk of neglecting on occasions when ‘moral panic’ governs approaches to mental disorder in the community. One of the tasks of working with or caring for the mentally ill is to evaluate, to observe and to manage risk, and on account of this task to make sound decisions concerning the lives of mentally ill clients. As argued by Davis (1996), there is a component of risk assessment in most features of the task, from the decisions that influence the liberty of individuals and the amount of assistance and support they receive, to decisions about policy on resources provision. Social workers can only accomplish these assessments if they are capable of recognising the certainty of risk and to take into account their responses to it. Two such responses were identified by Davis (1996) as those of risk minimisation and risk-taking, asserts that “Risk-taking is... an essential element of working with mental health service users to ensure autonomy, choice and social participation. It is a means of challenging the paternalism and over protectiveness of mental health services” (Davis 1996: 114). Elements of paternalism and over-protectiveness are features of the condition of risk minimisation apparent in guidelines of care management, care programming (CPA), documentations of hospital discharges and supervision records which, if professionals are not cautious, could result in needless controls being placed on the liberty of individuals diagnosed as being a threat to themselves and to others (Tew 2005). This consequently curbs the likelihood of integrating individuals with mental illness in their communities. Social workers have to find a neutral ground between being overcautious by needlessly restricting the experiences of their own and of their clients, and being inconsiderate by putting themselves and others in excessive risk (Gitterman 2001). Social workers are concerned with delivering the most favourable and beneficial mental health service for carers and service users. This suggests a service that is helpful, involves carers and service users in the process of decision making and is risk-free for all involved (Garlick 2007). Risk-free, effectual mental health services adopt a developed approach to risk, in which managing risk is defined as “the culture, processes and structures that are directed towards realising potential opportunities whilst managing adverse effects” (Garlick 2007: 14). This framework deviates from a crude risk perspective in mental health as relating mainly to risks occurring from service users, and rather sees risk as complex and multi-dimensional, and highlights the possible benefits as well as the dangers of risk taking (Austrian 2000). This essay takes on this broader perspective, where risk management process is not merely concentrated on removing risk, but on understanding possible gains while lessening the possibility of harms arising as an outcome of risk taking. Thinking about Risk Mental illness makes any person behaviourally and emotionally impulsive. There is no prescription or government intervention that is going to purge either mental illness or risk, even though a number of debates would indicate that this may be possible if only professionals could formulate a strategy of more effectively observing the behaviour of individuals with mental illness and of their health care providers (Austrian 2000). Such a perspective is an illustration of how people are coaxed both to make rush decisions and to disregard those things that they know, when having knowledge of them is painful or tiresome, or both. By itself it is an illustration of mental disorder within the human society. There are risks to clients, social workers and to the community in the tolerant and somewhat unrestrained and unregulated setting of the society. Mental health service users, since the 1990s, have become more and more described in terms of risk and precariousness, in spite of consistent empirical evidence that their role in societal violence is negligible (Potocky-Tripodi 2002). As mental health policy has further progressed in the path of regulating individuals identified to be a risk to others and to themselves, risk management and assessment is now a major condition for mental health practitioners (Nash, Munford & O’Donoghue 2005). The sustained emphasis upon risk implies that there is a chance that individuals so stigmatised will be barred from decision-making about their own lives. Self-protective response is also more probable (Nash et al. 2005). Risk to Others The behaviour of individuals in some studies involved inappropriate sexual behaviours, grave verbal threats, hostility, and assaults. At times staffs were uncertain whether an assault or aggressive action was caused by psychosis (Henderson 1994). For instance, one man in a study consented that he was a risk to himself and to other people when encountering psychosis, but he had been goaded into several brawls with other men, at times caused by racist cruelty (Henderson 1994). Self harm, suicidal ideas, and substance abuse were also characteristics of the lives of many service users, as were troubles such as discrimination, racism or distress originating from being an immigrant or having been exploited and abused in childhood (Tew 2005). Risk assessment and service users There were handfuls of cases where service users were totally involved in the process of assessing risk. Nevertheless, majority of service users and relatives were unaware of the fact that professionals were officially conducting risk assessments (Tew 2005). Most professionals have a tendency to make use of their simple checklists or own techniques to assess risk. Service users were seldom furnished risk assessment copies, even though numerous social workers would like to give an effort towards this (Padgett 1995). Most social workers in various studies claimed that they talked about risk with the service users, though numerous found this challenging. There are users who are not clearly aware that they were believed to create risk to other people and to themselves. Mental health practitioners found conversation easier when they are well-aware of the user, as well as their positive traits, and had a healthy relationship with them, developed over time (Padgett 1995). There are service users who could not be invited to participate in studies because they were unaware that staff regarded them a risk to other people (Gitterman 2001). This could have repercussions for civil liberties, and the usefulness of subsequent service responses. Several of the explanations provided against complete and straightforward discussion of risk were: anxieties for personal security or that this discussion would reinforce stigma and agonise or lead to disentanglement from services (Gitterman 2001). Explanations for discussing about risk to others involved the right of users to be informed of what is written about them, and enhanced reliance between mental healthcare provider and user, with the possibility of mutual risk management (Austrian 2000). Risk management Care plan for each service user included observing mental status as well as promoting compliance with prescription if they were unsure or hesitant to take medication. Documented risk management or decline preparations were seldom even though, during a number of studies, the Mental Health Trust formulated integrated care planning and risk management (Nash et al. 2005). Handfuls of service users were regarded by professionals as concerned and expressive about what they would like from the care plan. Descriptions and levels of involvement differed (Nash et al. 2005). Several mental health practitioners took involvement to suggest the user articulating their views whereas others implied that they had in fact manipulated the outcome. Only a small number of professionals talked about how to involve individuals who were not cooperative (Tew 2005). Current studies reveal that involvement of service users in risk assessment and management was unpredictable and relied upon individual professional programme. Handful of professionals was taking on methodical risk assessment or risk management schemes (Tew 2005). Research practitioners do not think that risks would be more truthfully evaluated if they were. Nonetheless, they propose that a format for risk assessment and management is formulated to guarantee that views of service users about risks are considered (Tew 2005). It appeared that numerous professionals were concerned in working towards the involvement of service users but found it challenging. An eagerness to take proper risks, discuss risk and look comprehensively at all features of an individual’s life, such as other troubles they may be suffering, such as distress, racism, etc., could go one way or another to facilitate more successful risk management (Henderson 1994). Cultures within organisations also influence the level to which healthcare providers feel restrained to practice self-protectively rather than justifiably (Henderson 1994). Social Case Work: Young Black Males with Mental Illness Several young black males and minority ethnic groups are revealed in some studies to have higher incidences of hospitalisation, enforced confinement, and interventions including isolation, compared to the general population (Stanley & Manthorpe 2002). The explanations for these variations are not completely understood but the bigger threat of mental health disorders may somewhat be caused by social inequality, marginalisation and anxiety, while services and treatment grounded on improper assumptions and damaging stereotypes also contribute to the problem (Stanley & Manthorpe 2002). These inequalities have become a major emphasis within mental health research and planning. It has been proposed that national programmes to enhance treatment across various social groups are not likely to be effective without an improved knowledge of the processes of decision-making that evidently result in these more coercive and invasive outcomes (Gitterman 2001). There is information/data that young males from black and minority ethnic group might be hesitant to seek help from services offered by mental health institutions and might postpone an attempt until a condition becomes out of hand (Stanley & Manthorpe 2002). Members of black and minority ethnic communities who use services and their healthcare providers usually reveal discontent with ordinary services which they frequently view as misrepresenting or misinterpreting their condition (Stanley & Manthorpe 2002). Services can be enhanced by encouraging the involvement and report of black and minority advocacy groups and service users in risk management and planning. For instance, Hillingdon MIND has formulated an array of services for mentally ill Asian people, such as drop-in centres, assisting plans, and associations for women with depression and anxiety, programmes which show the importance of working collaboratively with the local community (Austrian 2000). Assessing and managing risk includes a practised duty of care of those serving in mental health institutions towards the young black male service users, in which health needs are complemented with matters of individual and public security. Healthcare providers should complement the encouragement of client involvement in decision making and independence with the burdens of personal, professional, and public responsibility (Gitterman 2001). Risk management must not only put emphasis on removing risk, it is about presenting a mechanism for ascertaining the possible gains identified are strengthened and the possibility of problems arising as an outcome of taking risks are lessened (Gitterman 2001). As part of their daily task, mental healthcare providers is obligated to adhere to specific duties under legislations on health and safety, such as taking practical care to secure his/her wellbeing, and those of others (Potocky-Tripodi 2002). Nonetheless, the multi-dimensional notion of risk necessitates that the array of co-workers in mental health services each fulfil their function in successful managing of risk including the service user as well as the healthcare providers and family members. This can be realised most successfully through the kind of partnership operating represented in the recovery approach, in which these individual obligations can be clarified and discussed (Potocky-Tripodi 2002). Service users might need further assistance to understand and adhere to their obligations in this regard, such as support and guidance from an independent sponsor. Successful assessment and management of risk, which enthusiastically involves the user in the course of action, can and must be motivating and health cultivating (Tew 2005). A number of interventions can proffer risks to users, such as several forms of prescription which might have unfavourable side effects (Tew 2005). Hence the notion of risk is more comprehensive than often described or recognised. Conclusion Social workers of individuals with mental illness should keep in mind as much as they can. They should be consciously sensitive of the indications coming from themselves and from others, and to be ready to contend with the obvious discrepancies. They have to be roused by the voice inside them urging them ‘to be irrational’ or ‘not to be irrational’ at occasions when they are feeling nervous, so that rather than reacting by turning away, then contend with their feelings with higher regard. Simply put it, social workers should look for a mental space within themselves and a physical space outside themselves in which it is possible to witness and to take into account what is happening within them and around them. Social workers can all recognise situations in which it seems impossible to accomplish this: when they are preoccupied, running from one task to another, when the workplace is extremely disorganised that it becomes impossible to reflect and when they feel overwhelmed by too much disruption that it feels rather impossible to take into account anything. These are the occasions when social workers are most at risk. Rules and guidelines can be valuable constitutions for thinking, as long as they are used to this purpose. Management that promotes thinking is important to successful risk task, but this can also be difficult to find. It is essential to hold personal power and influence in the work, but guidelines that seem to be always monitoring the worker weakens this. On occasions social workers may even feel coaxed to behave or act against their better judgment so as to be able to say ‘I already told you’ when a crisis occurs. However, when the outside environment is capable of providing workers with chances for building healthy relationships with managers and co-workers, enduring relationships with service users and clients, and successful inter-agency partnership, then they are capable of reflecting about risk and to make decisions that are sensitive to the varying demands of individual clients. References Austrian, S. G. (2000) Mental Disorders, Medications and Clinical Social Work, New York: Columbia University Press. Davis, A. (1996) Risk work and mental health. In H. Kemshall, Good Practice in Risk Assessment and Risk Management, London: Jessica Kingsley. Garlick, A. (2007) Estimating Risk, London: Ashgate Pub Co. Gitterman, A. (Ed.). (2001) Handbook of Social Work Practice with Vulnerable and Resilient Populations, New York: Columbia University Press. Henderson, G. (1994) Social Work Interventions: Helping People of Color, Westport, CT: Bergin & Garvey. Nash, M., Munford, R., & ODonoghue, K. (2005) Social Work Theories in Action, London: Jessica Kingsley. Padgett, D. (Ed.). (1995) Handbook on Ethnicity, Aging and Mental Health, Westport, CT: Greenwood Press. Potocky-Tripodi, M. (2002) Best Practices for Social Work with Refugees and Immigrants, New York: Columbia University Press. Stanley, N. & Manthorpe, J. (2002) Students Mental Health Needs: Problems and Responses, London: Jessica Kingsley. Tew, J. (Ed.). (2005) Social Perspectives in Mental Health: Developing Social Models to Understand and Work with Mental Distress, London: Jessica Kingsley. 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