1 Risk, practice and the law Ben Hannigan

2 Aims Today we will: consider the relationship between risk and practice catch up on the review of the MHA 1983

3 Risk and mental health “Risk” increasingly permeates the worlds of policy, practice and research See, for example, the Revised Adult Mental Health NSF

4 Policy Key Action 31 All service providers are to review annually their risk management strategies in the light of any lessons learnt or information generated by the CPA, untoward incidents and complaints. Such reviews should inform clinical governance, management arrangements and practice, and where required have an identifiable action plan to address any issues raised. Health and Social Care agencies to develop cross agency risk management strategies where appropriate. Welsh Assembly Government (2005) Raising the Standard: the Revised Adult Mental Health National Service Framework and an Action Plan for Wales. Cardiff: Welsh Assembly Government.

5 Practice No national guidance exists on the production of risk assessment proforma (RAP)… …typically, each trust develops its own… …leading to wide variations across organisations Hawley C.J., Littlechild B., Sivakumaran T., Sender H., Gale T. and Wilson K.J. (2006) Structure and content of risk assessment proformas in mental healthcare. Journal of Mental Health 15 (4)

6 Research Dedicated journals, such as Health, Risk & SocietyHealth, Risk & Society A rise in published papers focusing on risk and mental health, produced by writers in different fields (medicine, nursing, sociology, psychology, policy, epidemiology, etc.) Heyman B. (2004) Editorial: risk and mental health. Health, Risk & Society 6 (4)

7 ‘Risk’ as a problematic concept ‘Risk’ is disputed – what ‘it’ is, and how ‘it’ can be measured In mental health contexts, ‘risk’ usually refers to three phenomena: -risk to self -risk to others (usually through acts of violence) -risk of self-neglect

8 ‘Risk’ as a problematic concept But: “Risks, however, are selectively perceived: we attend to some and ignore others. Equally our perception of risks is not unbiased. Consequently, we need to examine the factors that underpin the prioritising of risks and the biases in our perception. Some risks may not be recognised […]” (Busfield 2004, p364)

9 ‘Risk’ as a problematic concept There are, for example, risks associated with psychotropic medication Busfield J. (2004) Mental health problems, psychotropic drug technologies and risk. Health, Risk & Society 6 (4) And risks posed by the community to people with mental health problems Kelly L.S. and McKenna H.P. (1997) Victimization of people with enduring mental illness in the community. Journal of Psychiatric and Mental Health Nursing 4 (3) Kelly S. and McKenna (2004) Risks to mental health patients discharged into the community. Health, Risk & Society 6 (4)

10 However… Driven, in part, by events such as the murder of Jonathan Zito in December 1992 by Christopher Clunis, and the subsequent publication in 1994 of the Report of the Inquiry into the Care and Treatment of Christopher Clunis …Report of the Inquiry into the Care and Treatment of Christopher Clunis …reviewing the legal framework for mental care has become a government health and social care priority

11 Review of the MHA 1983 Commenced in 1998… …became a highly protracted and controversial process… …in which government proposals faced strong opposition from professional and service user groups through the work of the Mental Health AllianceMental Health Alliance

12 Timeline Go to: nce/Healthandsocialcaretopics/Mentalh ealth/DH_ nce/Healthandsocialcaretopics/Mentalh ealth/DH_

13 Mental Health Act 2007 Go to: ce/Healthandsocialcaretopics/Mentalhe alth/DH_078743

14 What do you think about… Changes to professional roles? Supervised community treatment?