Transcript Module 8: Risk - Dual Diagnosis

Module 8: Risk
Objectives
• To be aware of the kinds of risks
associated with dual diagnosis
• To be aware of how substance use and
mental health increase risks of violence
and self-harm
• To be able to identify risks and develop a
risk management plan
Dual Diagnosis Capabilities
• Assess risks and devise a management plan in
conjunction with service user and other relevant
personnel, ensure that all parties are aware of
their own role in risk management. Dual
Diagnosis Capability 10 level 2
• Multi-agency/professional working: To
understand the roles and responsibilities of the
range of professionals and service providers,
and to share care, and work in partnership with
them. Dual Diagnosis Capability 15 level 2.
Exercise 1: Risks associated with
dual diagnosis
• Thinking about your work experience,
what are the risks associated with people
with co-morbid mental health and
substance use problems?
• Discuss in pairs, and make a list. (10
minutes)
Risks
• People with dual diagnosis are far more likely
than people with single diagnoses to be at risk of
harm either to themselves or others.
• Risks include:
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violence
suicide
self-harm
accidental overdose from alcohol and/or illicit drugs,
self-neglect and malnutrition.
physical health problems (such as blood borne
viruses and injecting related problems)
– victimisation (bullying).
Risk Management
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Requires effective interpersonal and engagement skills, good
communication between service user and all the services involved in their
care, good support, and monitoring.
It is almost impossible to prevent every untoward incident from occurring,
but a lot can be done to minimize the risk and reduce the likelihood of it
occurring.
The service user should be placed at the centre of any risk management
plan, and their needs should be addressed as far as possible.
However there will be times in which the needs of the individual cannot be
met as this poses a threat to others.
This dilemma needs to be managed with as little confrontation as possible
and with as much dignity as possible for the service user.
– For example, if you are aware that the person is likely to harm a relative then
immediate action should be taken in order to prevent this. This may involve
informing the relative of the threat posed, or preventing the service user from
access to that person until the threat has subsided or if the safety of that person
can be protected (supervised contact for example).
Recommendations From “Avoidable Deaths”
(National Confidential Enquiry into Homicides and Suicides by those with
Mental Illness 2006)
• Reduce levels of absconding as deaths occurred after
absconding from inpatient wards
• Transition from ward to community- ensure a safe
transition from ward to home.
• Use of CPA and management of risk- comprehensive
risk assessment and high risk service users subject to
enhanced CPA (including substance users).
• Responding quickly when a care plan breaks down
• Improve observation on inpatient wards.
• Change attitude of “inevitability” towards suicides by
people with mental illness
• Improve services for dual diagnosis
Exercise 2 : Risk identification
and Management
• In small groups, read scenario then consider:
• What are the main concerns you would have
about this man?
• From the case history, make a list of the risk
factors and explain why they are significant
• What kind of risk management plan would you
want to implement?
• Who would be involved in this plan?