The needs of the elderly are almost never considered beyond their age-related health problems. Community services remain geared towards younger era more specifically children and teenagers, while elderly people's needs have a tendency to be regarded peripherally. A question that springs in your thoughts is how risk is evaluated in an more mature person with mental health issues.
A starting point is to take a look at a description of risk. Risk can be defined as 'the opportunity of beneficial and hazardous outcomes and the likelihood of their event in a mentioned timescale' (Alberg et al in Titternon, 2005). Risk is also a common feature in diagnosis frameworks by businesses and guidelines in social health care and health. Hence the need to attach value to risk issues in a number of public queries. However, these seem to be mostly related to child death inquiries where risk examination and risk management have emerged as the ongoing needed requirements to boost best practice. Most available clinical tests of risk and older people seem to concentrate on falls and other everyday risks they could encounter when wanting to return home after having a hospital admission.
Langan & Lindlaw (2004) comment that mental health service users have become increasingly defined in terms of risk and dangerousness, despite constant research data that their contribution to violence in population is nominal. They further stipulate that extended focus after risk means that there is a danger that individuals so described will be excluded from decision-making about their lives. This may be related to theory and research facts that shows that although the elderly with mental health needs are in increased risk of entrance to long-term care, staff usually do not be well informed about their mental health needs (Nicholls, 2006). This could be related with mental health issues coexisting with other medical conditions in later life, resulting in this client group being commonly treated in mainstream settings rather than mental medical institutions.
In regards to legislation and policy that features risk assessment, we have the NHS and Community Attention Take action (1990) which spells out the duty to assess those in need of community care and attention services. More specifically to associated risk related interventions, these should be the least restrictive and clients should be encouraged to make use of their own resources or develop new ones according to Mental Health Action (1983), Mental Capacity Function (2005) and Safeguarding People. Moreover in context of the National Service Construction for Older People (2001) 'person-centred care' is key, where in fact the aim is ideal for older people to be treated as individuals and get appropriate and timely packages of attention which fulfills their needs as individuals, irrespective of health and public services boundaries (DH, 2001). The No Secrets instruction (2000) encourages services users to get increased control of their lives when you are given the possibility to take and control risks. Addititionally there is the Risk and Choice Framework (2007) which gives guidance on risk assessment and tools.
However, current coverage and legislation seems to maintain long-held ageist assumptions about capacity and capacity. For instance, the NSF for THE ELDERLY (2001) and Substance of Health care (2003) require providers to ensure that look after this customer group is fully integrated and all natural in characteristics. Hence the designed use of the FACS (Fair Access to Care and attention Services) requirements to ensure equality. Yet, these eligibility requirements can prevent an important concentrate on an older person's biography in conditions of the advantages and abilities they gained over their transitional activities. In this instance, policy relating to risk assessment must consider the impact of age and life course level.
Moreover, has concluded by McDonald (2010) legislation together will not change the way in which professionals react to older people and further analysis is needed with regards to the factors that impact decision making in the context of risk.
Through our life expectancy risk can be regarded as beneficial and part of day-to-day life as it allows learning and understanding. However, one cannot dismiss the negative effects of risk and eventually the need for it to, at times be monitored and constrained. Thus risk analysis becomes a significant element of several frameworks.
Risk evaluation has been defined as 'the procedure for estimating and evaluating risk, known as the likelihood of beneficial and dangerous outcomes and the probability of their incident in a mentioned timescale' (Titterton, 2005: 83).
In that framework, such process should check out a situation or decision, identify the chance and qualify/rate it in terms of possibility, harmfulness or even low, medium or high risk. Thus, a risk evaluation will only identify the probability of harm a risk may have to the related consumer and others. Consequently, intervention strategies should target at reducing damage. Irrespective of this a risk analysis cannot prevent risk (Expectation and Sparks, 2000) & most types of risk examination recognise that it's not possible to get rid of risk, despite the pressure on general public authorities to look at protective risk management (Electricity, 2004).
This protective risk management could very well be in response to some of the visible circumstances dominated in the mass media over the recent years, which has directed the focus of community worry plan to minimise risk. Also the government current emphasis on risk as it pertains to mental health related happenings/cases conveys an extremely misleading subject matter to the general public which in converts seems to donate to the defensive mother nature found in the experts that carry analysis and are meant to support this consumer group.
As commented in the Health Select Committee (2000) the current "blame culture" dangers driving away much needed staff from mental health services. The parallel concern becomes what are acceptable risks and how these might issue with the plan of person-centred assessments and end user empowerment. As put in Carr (2011) protective risk management or risk-aversive practice may bring about service users not being sufficiently backed to make selections and take control, hence being jeopardized.
Risk assessment isn't only about negative labelling with adverse consequences. It gets the value of promoting basic safety and, where necessary, identify appropriate intervention and support for service users. The methods most used in examining risk in communal work are: actuarial and medical methods. Adams, Dominelli and Payne (2009) state that the actuarial method entails statistical calculations of possibility where an individual's behaviour is forecasted on the basis of known behavior of other in similar circumstances; specialized medical assessment employs diagnostic techniques associated with personality factors and situational factors highly relevant to the risk behavior and the conversation between the two. This last mentioned is a lot more familiar method in sociable work practice. Both methods have limitations in conditions of generalising behaviour (actuarial method) and risk evaluation being truly a subjective process (scientific methods), i. e. inspired by assessor's track record, values and values. Therefore, it is central for pros to be aware of the restrictions of risk diagnosis tools.
Thus much, risk and its assessment seem to vary which reinforces the necessity for collaboration and collaborative working as a means frontward in integrating health insurance and social health care to provide a person centred support to mental health service users. Alaszewski and Alaszewski (2002) discovered that users, individuals and professionals acquired differing views about risk and basic safety. Nicholls (2006) identifies the Green Newspaper on Independence, Well-Being and Choice, which discovered that service users believe professionals are too worried about risk, and that this gets in the way of permitting service users to do what they want to do.
In regards to the elderly, the Single Examination Process stipulates the necessity for a coordinated strategy by which health insurance and social good care organisations interact to ensure person-centred, effective and coordinated good care planning (Nicholls, 2006). This entails showing information, trusting one another's judgement, minimizing duplication, and along ensuring that the range and intricacy of a mature person's needs are properly determined and addressed relative to their hopes and preferences.
Such collaborative working between professionals and service users can talk about potential conflict, evaluate strengths, needs and risk where in fact the effectiveness of involvement may very well be improved and the outcomes for service users more positive (Adams, Dominelli and Payne, 2009).
The implications for communal work practice is usually that the needs for service users with mental medical issues frequently mix organisational and professional restrictions. For example, pros working with the elderly with mental health issues are more than likely to work alongside a variety of experts from different health and social care and attention disciplines and organisations. Thus, one needs to consider how organisational civilizations may impact or influence how risk is perceived as eventually assess. As put by Neil et al (2009, p. 18) risk decision making is often complicated by the fact that the individual or group taking your choice in not necessarily the individual or group influenced by the chance.
Waterson (1999) further suggests that specialists and users tend to disagree on the levels of risk, not least because risk is subjective and can apply to environments as well concerning people. Alaszewski and Manthorpe (1998) equally argue that risk is recognized differently by different professionals and allocating blame is one of the main concerns of public enquiries into failures of community care interventions.
As current world advances into a culture of blame and risk-aversion, there can be an emphasis on the need to minimise doubt about hazards and attribute individual culpability. As put by Parton (1998) 'blaming world' is now more concerned with risk avoidance and protective practice than with professional competence and welfare development. This protective form of interpersonal work in risk evaluation put at risk effective and open up collaborative and relationship working. Today's dominance of individual accountability (or culpability) will make social work lose view of their traditional ideals where service users are designed to be empowered to make up to date decisions about the potential risks they are ready to take and the support they feel they could need. As mentioned in Carr (2011) practitioners are less able to engage with individuals to identify safeguarding issues and enable positive risk tasking. Because of this issues of discrimination, inequality and anti-oppressive practice start emerging with a customer group that has already been vulnerable.
Both stigma and discrimination against older people is further accentuated by the diagnosis of mental health. It really is reported that older people with mental health needs are in greater risk of mistreatment than other sets of older people (Nicholls, 2006). When it comes to risk assessment, books stresses the need for mental health service users to be included in that process, to get choice and opportunities to take risks towards keeping their freedom and self-determination, as put by Lawson (1996: 55) 'risk taking is choosing whether or not to act to accomplish beneficial results in an knowing of potential harms'.
As discussed earlier risk taking is part of life, but all too often for older people the presence of any aspect of risk results the prescription of care alternatives or admission to residential treatment which might not exactly be the older people's own hopes. For example, in position experience when elderly clients were accepted to hospital the neighborhood authority main aim was to ensure clients remained at home for so long as possible nevertheless the package of treatment was delivered relative to the neighborhood authority's interpretation of these client's needs such as dictating bedtime regimens and dismissing the need for social connections. In this situation, the risk diagnosis tended to focus on the worker's interpretation of identified need. This may relate with the conclusions of Langan & Lindlaw (2004) study where service customer engagement in risk assessment was variable and depended upon individual professional effort. The concern here's that being overpreoccupied with risk is usually to the detriment of examining needs suggesting an initial nervous about organisational strategies and resource-allocation over service user's wellbeing. As put by Munro (2002) public work should be much more than minimising risk, it ought to be about maximising welfare. Carr (2011) further shows that this also impacts of practitioners' ability to activate with service end user to allow positive risk-taking, giving clients unsupported in taking control.
Discrimination could also occur has due to the amount of risk attributed to a service individual. Whereby over-estimation can result in unwarranted labels and under-estimation lead to improper service provision and/or risk to others (Langan & Lindlaw, 2004). Inflexible labelling is both unhelpful and frequently stigmatising. As found in research, people with mental health problems are a far greater risk to themselves than they may be to the general population and while there are occasions where intervention is required this will not be achieved in a manner that pigeonholes this client group as if the group of "dangerousness" (Tew, 2011) is only related to mental heath issues.
In an attempt to answer the initial question, of how risk is assessed in an old person with mental medical issues, risk evaluation of older people with mental medical issues is more likely to take place in turmoil situations. Hence interventions might be more reactive alternatively than proactive, where specialists' focuses on weaknesses and inabilities alternatively than strengths and abilities. Pros may 'play safe' by minimising risk at the trouble of consumer empowerment.
To better understand how risk, strengths and difficulties are assessed in regards to risk examination in the elderly with mental health needs (and other mental health service users) we have to place it in the context of current political and social belief. The last mentioned being significant given that research into triggers and ramifications of mental health in older people are limited, also there is bound research how mental health service users control risk. Therefore, it is essential that risk evaluation goes from a "one-size fit all" approach or a sort of tick-box exercise to being an inclusive process where in fact the individual included brings expert knowledge that needs to be incorporated into the examination of risk. As within Langan and Lindlaw (2004) few service users were fully involved in risk assessment. Likewise, Stalker (2003) refers to the omission from research of services users who are recognized to be at risk or a risk. Littlechild & Hawley (2010) suggest that little is known about how communal workers actually evaluate risk which judgements made by individual professionals can vary with all the same risk evaluation tools. Petch (2001) gives that overemphasising the importance of accurate risk assessment may lead to misleading conclusions about the amount of risk posed by someone and therefore expose this group to pointless restrictions.
From a few of the books review and research available risk may very well be a social construction, notion of risk differs between professionals (and service users) and contemporary society has its own normative views on risk and it's really overtly worried about the consequences of risk behaviour in relation to mental health. Furthermore, the role of the press in shaping and, one could argue, amplifying some of these concerns must be recognized. Nonetheless, this does not make risk inexistent. The main element appears to be for the needs and risk of mental health service users to be evaluated from a alternative approach, preventing judgements, inserting the service consumer at the centre and valuing their point of view as a adding expert while at the same time recognise that risk is contextual as well as its substance, i. e. risk can change.
Risk assessments have to be thorough and build on the bigger picture of the service customer by drawing on their strengths and aspirations. Tew (2011) reiterated that the prominent discourse around risk will pathologise service users where cultural and environmental framework is not considered. Also that contributes to a paternalistic practice where service user's needs are given for without considering their rights.
The concept of 'risk' is complicated, making its assessment challenging. That is reflected in different ideas and approaches to risk assessment as well as the inkling that people are moving to a risk dominated population. Because of this, the behaviour and behaviours of such world are weighed in insurance policy and practice with regards to service users with mental medical issues whereby isolated situations involving people with mental health issues become exaggerated to create perceptions that such customer group are inherently dangerous and need to be handled and confided (Gould 2010). Undisputedly, it is a significant challenge to receive the right balance when coming up with difficult risk decisions.
On the other side, risk assessments are needed to improve the validity and reliability of decision making specifically where there may be concerns about a person's capacity to make informed judgements. However, risk can't ever be eliminated totally, and sometimes decisions will be made in good trust, on the best research available.
As suggested by Stalker (2003) more studies are had a need to address the intricate characteristics of risk as well as positive-risk consuming relation to service users with mental health needs. This in addition to the dependence on research to add services users perspectives as well as other factors such as race and gender.
In regards to the elderly, if as a sociable group they have a tendency to be institutionally marginalised then it could be evenly easy to negate the views of individuals with mental health problems who equally test society's assumptions of functionality when it comes to controlling risk. Risk diagnosis is central to interpersonal work practice; however it should never depersonalise the service user and merely identify them by having a compilation of risk factors. And also the discourse around risk assessment needs to move from a concern about risk adversity to a probability of positive and negative risks. Equally antagonistic is the use of the term "dangerousness" to specify prone service users. Such language can effect on collaborative and relationship work between pros and service users. Furthermore, as put in Tew (2011) the ongoing rituals of risk assessment may impact further on service user's sense of home and undermine their capacity to manage dangerous situations. Also, as stated in Petch (2001) there will be people locally who cause risk, whether they have problems with mental health, and singling out or blaming a specific group of pros won't change this.
Thus, a risk analysis is made over a balance of probabilities alternatively than exact conclusions. While trying for uniformity within risk assessment is a move towards equity, flexibility is also important given the subjective contexts of risk and mental health needs. People's lives involve many changing and interrelated variables that may always create some difficulty in controlling risk assessment. In the end, life can't be without risk and risk-taking is part of the process which makes us who we are, intricate beings.