Minimizing Risk When Working With Service Users - Literature review Example

 To What Extent Should The Main Focus Of Social Work Practice Be On Minimising Risk When Working With Service Users Who Use Mental Health Services? Mental illnesses have a huge impact on the lives of many people worldwide. Mental health conditions are expensive due to loss of earnings, treatment and costs of welfare. Mental health patients are also faced with increased stigma, problems with recruitment and retention, attribution of blame and diminished morale [Sax07]. The conditions are a challenge to both the victims and their families. People with mental health problems often face stigmatization, isolation from peers and community and social exclusion.Mental problems are not recognised to be as a result of social injustice and oppression such as racism, discrimination, trauma or abuse as a child[Fis86]. Mental health conditions can be life threatening if left untreated and lead to behaviours that may deteriorate their physical health, for example, drug misuse and alcohol abuse, suicide, self-harm, and physical neglect[Vai12]. The most frequent health conditions that affect adults include mixed anxiety depressive disorder, obsessive compulsive disorder, panic attacks, and episodic moderate and severe attack and generalised anxiety disorder. Complex health conditions are rare and have more impact on the quality of life. Complex health conditions include schizophrenia, anorexia, personality disorders, post-traumatic stress disorders and bipolar disorders [Kes08] [Sax07] suggest that people who suffer long term mental problems mostly experience exclusion in the society and discrimination as a direct consequence of their complications.The main obstacles to better mental health care is courtesy of inadequate availability of resources such as mental health services, community resources and human resources. People with mental health problems experience inequities in their distribution and inefficiencies of their use. In addition, they experience poverty, unemployment, insecure housing and scarce social and support networks. Stigma can reinforce unimportant assumptions, poor coordination between agencies and a limited focus on the clinical aspects of mental health problems[Sax07]. In an environment where the views of people who use services are increasingly significant, the major challenge is providing an effective social support for persons with mental health problems especially in places that lack equity and dynamic organisational structures. Many people with mental health problems tend to avoid or fail to participate from mental health services due to stigma. Stigmatisation leads low self-esteem and denies people with social opportunities [Cor04]. Social workers provide health and social services for people with mental health problems in statutory community mental health teams, integrated or multidisciplinary teams, assertive outreach and crisis intervention. [Ray08] Adult mental health social workers aid in improving the mental health services for service users. Their basic role is to coordinate and deliver services to the people with mental health problems [All14]. The specialist social worker is expected to deliver key priorities such as promoting recovery, promoting capacity in the community, statutory care access, intervening in situations that are risky and highly complex for the individual and the society, balancing and protecting the rights of the different parties, make decisions on behalf of people within complicated legal frameworks and completely utilizing the professional leadership provided by Approved Mental Health Professionals, which is the core of their role [All14]. Social worker should take into account that persons using mental health services face stigma and discrimination. They should also be sensitive to the service users’ gender, sexual orientation, socio-economic status, age, disability and cultural, ethnic and religious background [Rog10]. They should be informed on variations in presentation of mental health problems in service users. The social care professionals should be competent in assessment skills and using explanatory models of illness for people from different cultural, ethnic, religious or other varied backgrounds [Rog10]. Social workers are able to support people make changes that are affirmative and self-directed due to their advanced skills based on relationship and focus on personalisation and recovery. In order to optimise involvement and collaborative solutions, social workers are trained to work in partnership with people using the services, families and carers. The relationship should be based on trust, empathy and warmth. It may be impossible to ensure full engagement but it is advisable to consider the potential[All14]. Social workers enable citizens access the statutory social care and social work and advice to which they are entitled, discharging the legal duties and promoting the personalised social care principles of the local authority[All14]. This is through undertaking assessments, determining eligibility and providing services under applicable social care legislation. The social workers facilitate fair access to social care funding and personalised support planning and personal budgets for people who are eligible. They work to safeguard adults by providing practice expertise and systems leadership and Mental Capacity Act expert practice and leadership[All14]. Social workers promote recovery andsocial inclusion with individuals and families. Intervening and showing professional leadership and skill in situations characterised by high levels of social, family and interpersonal complexity, risk and ambiguity. They work co-productively and innovatively with local communitiesto supportcommunity capacity, personal and family resilience, earlier intervention and active citizenship. They lead the Approved Mental Health Professional workforce [All14]. It is assumed that mental health service users are violent and are at a risk to themselves as victims of crime. The goal of social workers should be assessing and managing risk since the mental health policy has been advanced towards controlling persons who are at a risk to others. Risk assessment and management is a vital component and can lead to reduced rates of extreme incidents especially in homicides. This is because people who are violent are likely to give indication prior. Violent acts can be predicted and averted. There should be an inclusive and holistic approach to risk assessments which incorporate the knowledge of the social workers of the risks of risk assessments [Lit10]. Risk assessment within mental health assessment is necessary to establish if they pose as risk to others and themselves. There is a wide range of risk assessment from formal tools such as those that assess behaviour and suicidal thoughts to sets of questions on a comprehensive assessment forms. When conducting risk assessment it is important to ensure that they are completed in co-operation with the persons involved and that the details shared with relevant agencies[Ske11]. However, most service users are not actively involved in risk assessment. The relatives and friends to the health service users are not usually informed that social workers were assessing risks. The major components of risk assessment should consider the current symptoms of the mental ill health patients that would be an indication of risk such as having suicidal ideas, hearing distressing voices, impulsivity and thoughts of harming others. Current behaviour would suggest risk of harm to self and other people[Lit10]. If a person has previously used a mental health service and stopped attending advice against advice, had compulsory hospital admission, had contact with forensic services or terminated taking prescribed medication should be covered in risk assessment. Homelessness, financial vulnerability, recent severe stress, relationship problems and contact with the criminal justice system are personal circumstances that might increase risk. It is also important to educate people who use drugs and alcohol on the impact of how the substance on their health[Lit10]. After risk assessment has been conducted, it should result in a joint decision with the service user about the level of risk and a plan for managing the risk. In managing risk, both the social and healthcare professionals are involved therefore a multi-disciplinary plan should be put in place. The people involved such as family members should be also involved in the care of the individual. Poor risk assessment may lead to individuals being placed in inappropriate services with insufficient support. Risk assessment should also include a set of action plans, allocation of each aspect of the plan to an identified profession and date of review[Lit10]. Social workers should be able to recognise the strength of the service user together with the problems that may be encountered and those that might be present to ensure efficacy in risk management. When a problem is identified, a strategy should be suggested and discussed building on the affirmative skills of the service user. Emphasis should be focused on recovery and on the subsequent level the service user’s ability to cope when having difficult demands placed on them or feeling vulnerable. Risk factors are personal circumstances that may lead to a negative event by causing or facilitating an event occurrence. They can be categorised into static and dynamic factors. Static factors cannot be changed, and they include, history of child abuse or suicide attempts. Dynamic factors change from time to time for example drug and substance abuse. These factors can be aspects of the individual or the environmental and social context. Those dynamic factors that undergo a progressive change are referred to as stable factors while those that transform exponentially are known as acute factors[Yan10]. There are various assessment tools that have been designed to assess the risk of violence. This tools have improved predictive assessment since it is not possible to predict risk accurately. The tools are in two categories, the actuarial instruments and structured clinical guides. The actuarial instruments assess risk by attaching to specific statistical weighting to different variables. They are premised on the idea that if accuracy of prediction is the most important factor then it is recommended that to find out how members of a group that can be compared conducted themselvesover the period. It is effectively achieved by pain-staking follow-up research on a particular group over set periods of time. If follow up data on violence can be accessed, it is possible to link with various data obtained at an earlier time.Scores obtained from individuals can be related to statistical reference data[Yan10]. In structural clinical guides, clinicians consider a number of variables which have some application to the assessment of the risk in consideration to the case. The assessment is based on the idea that over the last twenty years, a lot has been learnt regarding the factors that should be taken in account when conducting risk assessments on various types of mental health. Violence risk management is the objective therefore it offers the most potential. The social worker combines an assessment of clearly defined factors derived from research, clinical experience and knowledge of the user and the service user’s own perspective of the experience[Yan10]. Risk management should focus on eliminating risk and providing a process for ensuring potential benefits identified are increases and the likelihood of harms occurring as a result of taking risks are reduced. The main aim is to ensure that risk events are assessed and ways of reducing the possibility of them occurring are reduced. It should be based on a plan to minimise the risk of a harm occurring and increasing the potential of a positive outcome. A risk management plan included awareness of the potential for changes in the level of risk over time [Nat07] People with mental health problems may face single or repeated acts of abuse. Abuse is a threat to safety, health and the well-being of individuals. It may be physical, verbal and psychological and may be due to neglect or failure and occurs when a vulnerable person is coerced[Cro10]. Physical abuse that persons with mental health problems experience include violent actions on the person such as hitting. They experiencesexual abuse including rape. They also face psychological abuse such as threats of harm, emotional abuse, intimidation and physical humiliation. In addition, people with mental problems experience financial abuse, neglect and omission acts, self-neglect, discriminatory abuse and institutional abuse, neglect and poor professional practice[Sax07]. Cases of typical hazards in adult abuse cases are the behaviour of the abuser, fear of the abuser, low self-esteem, and lack of insight, feeling of worthlessness, lack of confidence, physical dependency, confusion, loneliness and inability to call for help. The social worker who assesses the risk of harm must consider the level of dangerousness of the abuser. People with mental health problems are likely to engage themselves in alcohol consumption and this could lead to harm and abuse[Wei04]. Strategies should be put in place in order to ensure that the people with mental health are safeguarded from risk. To ensure implementation and effectiveness it is important to increase awareness of abuse and safeguarding within the community[Pri08]. Social workers should workwith persons with mental health problems to arrange their own care and safety. Any reports of abuse should be made since there are cases of investigations whose outcome has not been substantiated. Ensuring high quality care services to prevent abuse is a vital strategy in minimising risk [Pri08]. Social work in the mental health service department is often surrounded by fear. Social workers are told or see awful stories on the news regarding work place experiences. As a result, there has been the issue of stereotyping social work connected with mental health illnesses[Dul12]. Stereotyping has resulted in many social workers not taking up roles in the mental health units. Even the public as a whole is led to believe that social work connected with mental disorders is not a good practice. The public is made to believe that mental disorders are conditions that only a certain group of people who can develop them. In fact, the media has portrayed social work associated with mental illnesses as a dangerous occupation, reason being that, mental patients are commonly associated with violence physical assault on social workers at their places of work [Dul12]. According to trends in the general population, out of four individuals, one person is likely to develop a mental illness. This trend extends to the general population. Social workers view the treatment of mental health illness as a source of identity and as an [Dul12]. Why is this so? The reason is that when a social work is at work, he or she can specify exactly what it is they do. The rise in the number of persons suffering from mental health disorders has resulted in an increase in the demand for social workers who are knowledgeable in their treatment. This has led to uplift in the status of social work in the mental health area[Dul12]. However, in spite of the uplift, social work in mental health is faced by the issue of poor legislation which deals with the risk associated with social work in caring for mental health patients[Dul12]. Social workers are often faced with high risks of physical assault by mental health patients at their places of work. However, there is no clear legislation that guides on the specific measures that should be put in place by the employer to ensure that the social worker is covered [Dul12]. This means that it is left upon social workers to look after themselves when they are at the place of work. It is not ethical for a social worker to assault the mental health patient, however it cannot be deemed unethical to defend him or herself[Tre05]. In cases where social workers are protected at their work places, it is up to the employers’ efforts to ensure safety mechanisms are implemented to ensure that social workers are safe, to minimize the risk of being assaulted [Tre05]. Gender plays a huge role in determining the number of assaults social workers face. It is more common place for female social workers to be assaulted than male mental patients. This is not stated to disregard the female gender or display it as the weaker gender, however, trends indicate so. What are needed are the right legislative laws that will guide health institutions on the steps that they can take along with measures they can put so as to ensure that social workers are protected in their places of work.Different sexes experience different kindsof mental health problems. Women tend to have anxiety and depression while men indulge in substance abuse and antisocial behaviour. [Ros13] Good social practice states that a social worker should acknowledge that even mental health persons have a right to take risks [Web01]. Therefore, it is recommended that independence, self-determination and choice should be promoted. For instance, if an adult if a victim chooses to remain in an abusive relationship because she benefits from the abuser. It is vital to recognise the strength of the mental health service users when dealing with risks. 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