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7 - Management of the risk of violence in the community

James McIntyre
Affiliation:
Elmleigh Hospital, Hampshire
Laura Garrod
Affiliation:
Enfield & Haringey Mental Health NHS Trust, London
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Summary

Over the past 30 years, with the advent of community care, the establishment of functional community mental health teams and the use of SCT, psychiatric care is increasingly delivered in the community setting, often to patients who are acutely unwell and who in the past would have been treated on an in-patient unit. Furthermore, the management of violence in community settings is often problematic for a variety of reasons: the patient may be unknown to services, a response team may not be available, or the environment in which an assessment may take place may be unsuitable to manage the risk of violence.

Guidance on the psychiatric care of potentially violent patients in the community was provided by the Royal College of Psychiatrists in 2000. Its recommendations on the use of the care programme approach and risk management are now routine practice. The care programme approach provided mental health teams with a means to organise and record multiagency working in a standardised manner. The report emphasised accurate, simple and quick systems for information transfer when a patient's care is moved between teams, including clarity with GPs on the responsibility for prescribing. In parallel with processes for efficient multidisciplinary working, it identified risk as an essential aspect of each patient's assessment. It also defined minimum requirements for risk assessment, recommended a multidisciplinary, structured approach, flexible to change, and the need for staff training to support this.

The Royal College of Psychiatrists’ 2006 report on safety for psychiatrists defined the responsibilities of employing organisations such as NHS trusts for the safety of mental health professionals. These included statutory expectations with regard to policy, training and environment. The requirements included the need for trusts to develop policies on risk assessment in the community, reporting of untoward incidents, and on lone working. It highlighted the additional need for procedures to be put in place for support by other staff in emergencies and protocols for working with outside agencies such as the police.

Type
Chapter
Information
Prevention and Management of Violence
Guidance for Mental Health Professionals
, pp. 67 - 80
Publisher: Royal College of Psychiatrists
First published in: 2017

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