Skip to main content Accessibility help

Confidence in the face of risk: the Risk Assessment and Management Self-Efficacy Study (RAMSES)

  • Jaime Delgadillo (a1), Omar Moreea (a1), Hannah Outhwaite-Luke (a1), Toby Dace (a1), Brenda Nicholls (a1), Georgina Ramseyer (a1) and Veronica Dale (a2)...


Aims and method

To evaluate a comprehensive risk management programme. A Risk Assessment and Management Self-Efficacy Scale (RAMSES) was used to evaluate the impact of a clinical guideline and training course. Fifty-three psychological therapists were randomly allocated to training v. waiting list in a controlled, delayed-intervention design. Differences in mean self-efficacy scores between groups were examined using analysis of covariance (ANCOVA).


The RAMSES measure had adequate factor structure, internal consistency and construct validity. When adjusting for baseline scores and cluster design, the group exposed to training had a higher mean self-efficacy score than controls. Mean differences between groups were not significant after the control group received training, nor at 6 months' follow-up.

Clinical implications

Exposure to training and clinical guidelines can improve self-efficacy in risk assessment and management. An important advance put forward by this study is the specification of areas of competence in risk assessment and management, which can be measured using a psychometrically sound tool.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Confidence in the face of risk: the Risk Assessment and Management Self-Efficacy Study (RAMSES)
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Confidence in the face of risk: the Risk Assessment and Management Self-Efficacy Study (RAMSES)
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Confidence in the face of risk: the Risk Assessment and Management Self-Efficacy Study (RAMSES)
      Available formats


This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Jaime Delgadillo (


Hide All

Declaration of interest




Hide All
1 Luoma, JB, Martin, CE, Pearson, JL. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry 2002; 159: 909–16.
2 Pirkis, J, Burgess, P. Suicide and recency of health care contacts. A systematic review. Br J Psychiatry 1998; 173: 462–74.
3 National Institute for Health and Clinical Excellence. Self-Harm: The Short-Term Physical and Psychological Management and Secondary Prevention of Self-Harm in Primary and Secondary Care. NICE, 2004.
4 Office for National Statistics. Suicides in the United Kingdom, 2011. National Records of Scotland, Northern Ireland Statistics and Research Agency, 2013 (
5 National Mental Health Development Unit. National Suicide Prevention Strategy for England: Annual Report on Progress 2008. NMHDU, 2009.
6 Meltzer, H, Lader, D, Corbin, T, Singleton, N, Jenkins, R, Brugha, T. Non-Fatal Suicidal Behaviour Among Adults Aged 16–74 in Great Britain, Office for National Statistics. TSO (The Stationery Office), 2002.
7 Isometsä, ET, Heikkinen, ME, Marttunen, MJ, Henriksson, MM, Aro, HM, Lönnqvist, JK. The last appointment before suicide: is suicide intent communicated? Am J Psychiatry 1995; 152: 919–22.
8 Schulberg, HC, Bruce, ML, Lee, PW, Williams, JW Jr, Dietrich, AJ. Preventing suicide in primary care patients: the primary care physician's role. Gen Hosp Psychiatry 2004; 26: 337–45.
9 Mental Health Foundation. Truth Hurts: Report of the National Inquiry into Self-Harm Among Young People. MHF, 2006.
10 Heilbrun, K, O'Neill, ML, Strohman, LK, Bowman, Q, Philipson, J. Expert approaches to communicating violence risk. Law Hum Behav 2000; 24: 137–48.
11 Munro, E, Rumgay, J. Role of risk assessment in reducing homicides by people with mental illness. Br J Psychiatry 2000; 176: 116–20.
12 Saxon, D, Ricketts, T, Heywood, J. Who drops-out? Do measures of risk to self and to others predict unplanned endings in primary care counselling? Counsel Psychotherapy Res 2010; 10: 1321.
13 Department of Health. National Suicide Prevention Strategy for England. Department of Health, 2002.
14 Department of Health. Best Practice in Managing Risk. Department of Health, 2007.
15 Department of Health. National Service Framework for Mental Health: Modern Standards and Service Models. Department of Health, 1999.
16 Department of Health. Safety First: Five-Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Department of Health, 2001.
17 Stein, W. Modified Sainsbury Tool: an initial risk assessment tool for primary care mental health and learning disability services. J Psychiatr Ment Health Nurs 2005; 12: 620–33.
18 Hawley, C, Littlechild, B, Sivakumaran, T, Sender, H, Gale, TM, Wilson, KJ. Structure and content of risk assessment proformas in mental health care. J Ment Health 2006; 15: 437–48.
19 Langan, J, Lindow, V. Living with Risk: Mental Health Service User Involvement in Risk Assessment and Management. Policy Press, 2004.
20 Doyle, M, Earnshaw, P, Galloway, A. Developing, delivering and evaluating interprofessional clinical risk training in mental health services. Psychiatr Bull 2003; 27: 73–6.
21 Garrett, T, Rowe, R. Violence risk assessment training for local mental health services. Br J Forens Practice 2004; 6: 13–7.
22 Raven, J, Rix, P. Managing the unmanageable: risk assessment and risk management in contemporary professional practice. J Nurs Manag 1999; 7: 201–6.
23 Bandura, A. Self-efficacy: toward a unifying theory of behavioural change. Psychol Rev 1977; 84: 191215.
24 Bandura, A. Self-Efficacy: The Exercise of Control. Freeman, 1997.
25 Mailbach, E, Murphy, DA. Self-efficacy in health promotion research and practice: conceptualisation and measurement. Health Educ Res 1995; 10: 3750.
26 O'Ferrell, B, Ford-Gilbo, M, Wong, C. Evaluation of an advanced health assessment course for acute care nurse practitioners. Can J Nurs Adm 2000; 13: 20–7.
27 Learman, LA, Gerrity, MS, Field, DR, van Blaricom, A, Romm, J, Choe, J. Effects of a depression education program on residents' knowledge, attitudes, and clinical skills. Obstet Gynecol 2003; 101: 167–74.
28 Lorenz, R, Gregory, RP, Davis, DL. Utility of a brief self-efficacy scale in clinical training program evaluation. Eval Health Prof 2000; 23: 182–93.
29 Bandura, A, Cervone, D. Self-evaluation and self-efficacy mechanisms governing the motivational effects of goal systems. J Pers Soc Psychol 1983; 45: 1017–28.
30 National Institute for Health and Clinical Excellence. Anxiety (Amended): Management of Anxiety (Panic Disorder, with or without Agoraphobia, and Generalised Anxiety Disorder) in Adults in Primary, Secondary and Community Care. NICE, 2007.
31 National Institute for Health and Clinical Excellence. Depression: The Treatment and Management of Depression in Adults (Updated Edition). National Collaborating Centre for Mental Health, 2010.
32 National Institute for Health and Clinical Excellence. Common Mental Health Disorders: Identification and Pathways to Care. National Collaborating Centre for Mental Health, 2011.
33 Department of Health. Drug Misuse and Dependence: UK Guidelines on Clinical Management. Department of Health, 2007.
34 Schumacher, JE, Engle, M, Reynolds, K, Houser, S, Mukherjee, S, Caldwell, E, et al Measuring self-efficacy in substance abuse intervention in obstetric practices. South Med J 2000; 93: 406–14.
35 Murdock, TB, Wendler, AM, Nilsson, JE. Addiction Counseling Self-Efficacy Scale (ACSES): development and initial validation. J Subst Abuse Treat 2005; 29: 5564.
36 Nagy, MS. Using a single-item approach to measure facet job satisfaction. J Occup Organ Psychol 2002; 75: 7786.
37 Bryant, FB, Yarnold, PR. Principal components analysis and exploratory and confirmatory factor analysis. In Reading and Understanding Multivariate Statistics (eds Grimm, LG, Yarnold, RR): 99136. American Psychological Association, 1995.
38 Nunnally, JC. Psychometric Theory (2nd edn). McGraw-Hill, 1970.
39 Dace, T, Outhwaite-Luke, H, Russell, C, Bee, A. Guidelines for the Management of Clients within the Primary Care Mental Health Service at Risk of Harm to Self and Others. Leeds Community Healthcare NHS Trust, 2010.
40 Newcastle, North Tyneside and Northumberland Mental Health NHS Trust. Suicide Risk: A Guide for Primary Care and Mental Health Staff. Northumberland, 2001 (
41 Oquendo, MA, Malone, KM, Mann, JJ. Suicide: risk factors and prevention in refractory major depression. Depress Anxiety 1997; 5: 202–11.
42 Kerry, SM, Bland, JM. Analysis of a trial randomised in clusters. BMJ 1998; 316: 54.
43 Matthews, JNS, Altman, DG, Campbell, MJ, Royston, P. Analysis of serial measurements in medical research. BMJ 1990; 300: 230–5.
44 Richards, DA, Suckling, R. Improving access to psychological therapies: Phase IV prospective cohort study. Br J Clin Psychol 2009; 48: 377–96.
45 Royal College of Psychiatrists. National Audit of Psychological Therapies for Anxiety and Depression (National Report 2011). Royal College of Psychiatrists, 2011.
46 Linehan, MM, Heard, HL. Impact of treatment accessibility on clinical course of parasuicidal patients. Reply. Arch Gen Psychiatry 1993; 50: 157–8.
47 Liberman, RP, Eckman, T. Behavior therapy vs. insight-oriented therapy for repeated suicide attempters. Arch Gen Psychiatry 1981; 38: 1126–30.
48 Calabro, K, Mackey, TA, William, S. Evaluation of training designed to prevent and manage patient violence. Issues Ment Health Nurs 2002; 23: 315.
49 Huang, HL, Shyu, YI, Chen, MC, Chen, ST, Lin, LC. A pilot study on a home-based caregiver training program for improving caregiver self-efficacy and decreasing the behavioural problems of elders with dementia in Taiwan. Int J Geriatr Psychiatry 2003; 18: 337–45.
50 Papadopoulou, K, Dimitrakaki, C, Davis, H, Tsiantis, J, Dusoir, T, Paradisiotou, A, et al The effects of the European Early Promotion Project training on primary health care professionals. Int J Ment Health Promotion 2005; 7: 5462.
51 Tierney, E, Quinland, D, Hastings, RP. Impact of a 3-day training course on challenging behaviour on staff cognitive and emotional responses. J Appl Res Intellect Disabil 2007; 20: 5863.
52 Armitage, CJ, Conner, M. Efficacy of the theory of planned behaviour: a meta-analytic review. Br J Soc Psychol 2001; 40: 471–99.
53 Bandura, A. Self-efficacy mechanism in human agency. Am Psychol 1982; 37: 122–47.
54 Richter, D, Needham, I. Effects of aggression management trainings for mental health care and disability care staff – systematic review. Psychiatr Prax 2007; 34: 714.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 2053-4868
  • EISSN: 2053-4876
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Confidence in the face of risk: the Risk Assessment and Management Self-Efficacy Study (RAMSES)

  • Jaime Delgadillo (a1), Omar Moreea (a1), Hannah Outhwaite-Luke (a1), Toby Dace (a1), Brenda Nicholls (a1), Georgina Ramseyer (a1) and Veronica Dale (a2)...
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *