Item 31

Risk assessment and management

Target

a) Risk assessment: a structured risk assessment proforma is used documenting identified risks of self-harm or suicide, self-neglect, exploitation by others and harm to others + clearly identifying contact with children and vulnerable adults and potential related risks to them for at least 80% of service users.

b) Risk management: there is an individualised risk management plan covering all identified risks, which states the current CRT response and plans in the event of an increase in risk, for at least 80% of service users.

c) There is evidence that risk assessments and management plans are reviewed by staff during CRT  care and changed where appropriate as perceived risks change and/or management plans require change.

d) CRT staff training in safeguarding children and vulnerable adults is up-to-date in line with service guidelines and staff show awareness of thresholds for contacting other agencies; (met = at least 80% of staff team trained within time period specified in national and local guidelines).

e) High risk service users are identified and prioritised at CRT team level (e.g. specifically discussed at handovers, on team boards). 

f) The CRT can provide staff to stay with service users at home for extended periods (up to 4 hours) to manage risks in exceptional circumstances (e.g. carer absence, start of medication).

Why this is important

Service users under CRT care are likely to present with higher levels of risk, which may change rapidly over the period of care. It is therefore crucial that the CRT has robust risk assessment and risk management procedures which are fully documented. Procedures should be in place for higher risk service users, both in terms of continued management of the risks they present and the ability of the CRT to respond flexibly and intensively to any changes in risk.

Ways of doing this well 

Risk Assessment 

• Crawley CRHT Risk and Mental Health Care Plan (.doc)
• Camden CRT Clinical Risk Assessment and Management Guide (.pdf)
• Clinical risk management guidance (.pdf)
• Department of Health - best practice in managing risk (.pdf)

Examples of good practice

In our fidelity review survey of 75 crisis teams in 2014, the following teams achieved excellent model fidelity, and can be contacted for advice about how they achieved this:

• Witshire North Intensive Team, Avon & Wiltshire Mental Health Partnership NHS Trust
• West South Staffordshire (Stafford) CRT, South Staffordshire & Shropshire Healthcare NHS Foundation Trust
• Sunderland, Northumberland, Tyne and Wear NHS Foundation Trust
• Pontypool CRHTT, NHS Wales
• Gateshead CRT, Northumberland, Tyne and Wear NHS Foundation Trust
• South Powys HTT, NHS Wales
• Waltham Forest HTT, North East London NHS Foundation Trust
• Hastings CRT, Sussex Partnership NHS Foundation Trust
• Manchester North, Manchester Mental Health and Social Care Trust
• Brighton & Hove CRHTT, Sussex Partnership NHS Foundation Trust
• North West Sussex (Crawley) CRT, Sussex Partnership NHS Foundation Trust
• Surrey East (Redhill) HTT, Surrey and Borders Partnership NHS Foundation Trust
• South East Kent (Canterbury) CRHTT, Kent and Medway NHS and Social Care Partnership Trust
• Bath Intensive Team, Avon & Wiltshire Mental Health Partnership NHS Trust
• Mendip CRHTT, Somerset Partnership NHS Foundation Trust 
• Teignbridge CRHTT, Devon Partnership NHS Trust
• South Hams and West Devon CRHTT, Devon Partnership NHS Trust
• Taunton and Bridgewater CRHTT, Somerset Partnership NHS Foundation Trust 
• Chichester CRHTT, Sussex Partnership NHS Foundation Trust
• Wolverhampton CRHTT, Black Country Partnership NHS Foundation Trust

Relevant reading