Risk Assessment Research Health And Social Care Essay

Risk Assessment Research Health And Social Care Essay Risk assessment of the potential of violence to self or others has been accepted as a core element of clinical practice in psychiatric forensic community and private clinical environmental settings (Stedman et al., (2000). Risk assessment increases the ability to understand an individuals potential for violent behaviour, assists the individual to change and for organisations to better allocate limited resources to more effective treatment programs (Snowden et al., 2009). There is a significant correlation between substance abuse, psychiatric disorders, non-compliance with medication and the likelihood of aggressive behaviour amongst those with significant mental illness (Daffern et al., 2002). The link between medication noncompliance, violence and the effect medication noncompliance has on the over use of alcohol and other substances needs to be taken into account in conducting a risk assessment (Swartz et al., 1998). Daffern (2002), highlights the need for clinicians to be aware of the link between aggressive behaviours, the influence other environments and personal interactions outside of the hospital situation have on the patient and the need to take this into account when developing any risk assessment plan. There needs to be considerable care taken in developing a risk management plan to ensure that the plan does not focus on control and moves away from the primary goal of management (Heilbrun, 1997). Case Study Risk Assessment Plan James presents with three main issues that need to be focused on in the risk assessment plan. James has ongoing symptoms that would appear to indicate schizophrenia, but a more detailed assessment will need to be conducted. James has issues related to his aggressive behaviour towards others when he feels overwhelmed by his delusion schizophrenia symptoms. The first indicator of these symptoms was when he was 21 and believed he was being watched by cameras at his place of work. James reports that this delusional belief resulted in James assaulting a co worker and that police were involved and he was subsequent hospitalised. James reports twice assaulting his father when he believed his father was in his head. The James also reports a history of using illicit drugs since his early teens at high school. James reports that his marijuana use has been regular since early teens and he has on occasions misused prescription drug Valium. In adulthood, James reports use of beer and vodka has go ne from weekend binge drinking to regular four to five days a week of heavy use of beer and spirits. James also reports his tobacco use has been regular since early teens and has increased to heavy use of 30 cigarettes a day over the last 12 months. This last 12-month period also is reported by James as a period where he has increased significantly his abuse of alcohol and marijuana. From James presentation during the interview, it would be reasonable to assume that he is minimising he level of substance use. Another issue that influences James symptoms and behaviours is the noncompliance with prescribed medication, which needs to be addressed in the overall risk assessment plan (Swartz et al., 1998). Aggression Antonius et al. (2010), highlights the value of risk assessment as a valuable tool to assist the clinician to predict and prevent future violence and to improve current treatment and management protocols. Howells (1996), postulates that it is not possible to eliminate all risks of violence by forensic mental health patients, but therapeutic programs can be effective in changing violent behaviours. Although James level of violence would appear, from his self-report, to be on the lower level of violence, there appears to be in recent time a sense within James that he is becoming overwhelmed in the last 12months. This is indicated by not only what he says but also his use of substances, alcohol and tobacco usage has increased significantly in the last 12 months.. The potential for committing acts that are more violent can also be assumed to be increasing. Snowden et al. (2009), found that the testing with the Classification of Violence Risk (COVR) showed good validity when attempting to assess the risk of violence amongst patients with a history of violence and mental health issues. However, Snowden (2009), also warns that the COVR test requires information from patient files as well as patient self-report, and test results may be affected by the patient who minimises their history or violence, and the lack of access to the patients file. In this case, James presents as guarded in his answers to many questions and clearly only wanted to be out of the hospital, hence there would be a high probability of James minimising his level of violent behaviour. The mention that the police were still outside would give an indicator that they may have more knowledge of James past level of violence. Doing a clinical interview to assess the level of risk without the patients file, as was occurring in this instance, would appear unwise and places the interview into a clinical interview format with low predictor validity (Steadman et al., 2000). The quality of the information that the person conducting the risk assessment has access to, will determine the effectiveness of the risk assessment process (Heilbrun, 1997). Actuarial risk assessments have been found to be significantly more valid in predicting violence than unstructured clinical interviews (Steadman et al.,2000). Hilton et al., (2001), argues that risk assessment of disordered offenders with a history of violence requires the use of actuarial assessment tools to enable a valid indicator in relation to danger to self or others. Howells (1996), argues the benefits of ensure risk management plans requires the individual to attend some form of anger management program, to assist the individual to learn more functional strategies for dealing with their current frustrations. Buchanan (2008), highlights the need for those conducting a risk assessment to be aware of the casual connection between mental disorder and violence. There needs to be more information obtained other than the basic demographic information of age, race, gender and relationship status, which should include family environment, history of victimisation of client, how a client spends their day all of which have been found to correlate with mental illness and violence (Buchanan, 2008). Substance Abuse and Non-compliance with Medication Swartz et al., (1998), found in their study that a combination of substance abuse history and a history of non-compliance with medication, either recent or long term, was found to have a significant association with violent behaviour. Swartz et al. (1998), also made the observation of a correlation between an individual with limited personal insight combined with poor understanding of their illness and role of medication. This non-compliance with medication may not be deliberate behaviour by the individual as non-compliance and substance abuse may be mutually reinforcing which results in self-medicating with alcohol and substances. James would appear to have been self-medicating for many years with a self-reported significant increase in approximately the last 12 months. James reports the misuse of prescription medication Valium at various times. James would appear to view medication as only effective if it gives an immediate reaction and would need to have medication education as pa rt of formulating an effective risk assessment/risk management plan. Any risk management plan for James would also need to incorporate a community based specialised out patient program focused on treating dually diagnosed mental illness clients (Swartz et al., 1988). Research shows a high level of co morbidity between those suffering from a mental illness such as schizophrenia and substance abuse and violent behaviour (Daffern et al., 2002). Mental Illness Although James has admitted to no serious violent acts, his history of symptoms of schizophrenia with delusions elements would have to taken as a warning of potential risk to self or others. James reports that, in the last 12 months he has been finding it increasing difficult to cope. James presents as not having insight into his mental illness, and not wanting to be compliant in any medical treatment. Taylor (1998), found in her research that of the 309 people with psychosis who had killed, the large majority (75%) were deluded at the time of their offence (p49). Patient presentation must be observed carefully when assessing risk of violence apart from the obvivious features of psychosis that may be present, but also delusions may produce symptoms of anxiety or depression and delusions can indicate the patients inability to make or maintain relationships and history of violence (Taylor, 1998). James states during his interview that his illness had caused a break up of a past relatio nship and as a result had not been in a relationship for 3 years when he had to move back to live with his parents. Rogers (2000), makes mention of the need to take into account when conducting a risk assessment not only the risk factors but the protective factors, which are factors that may reduce maladaptive behaviours on the individual. In the case of James, he appears to have a closer connection to his mother than he does with his father. However, his mother would seem to be very passive and his fathers more dominate. James mother may well have a significant impact on James being more complaint with medication, if her assistance was incorporated into a risk management plan. Her participation in the management plan may well assist James to remain compliant with medication and assist in harm minimisation strategies in relation to alcohol and tobacco use by James. Swartz et al., (1988), also advised to be aware when doing a risk assessment on a patient exhibiting non compliance with medication and substance abuse that the patient may have some underlying personality traits that may need testing f or. James does not present as a threat to himself and reports no past history of self-harming behaviours and denies any current thought of self-harming ideation. However, James current file is not available to the interviewer and it would be unwise to accept James own statement as to his current mental state. James presents as depressed, agitated, reactive and extremely frustrated which would require the potential of self-harm to be incorporated for monitoring in any risk assessment, especially if he is kept in hospital for further psychiatric assessment. Douglas et al., (2009), reports that suicide/self-harm is a risk factor when the patient has a history of schizophrenia, violence and substance abuse. Close observation of James during the interview shows that he would go into a rocking motion on numerous occasions, did not maintain good eye contact with the interviewer and indicated a number of times his level of frustration about the time he had waited and not liking hospitals. The pr obability would be that James would be kept in the psychiatric ward of the hospital for 72 hours to allow for a complete psychiatric assessment to ascertain his level of threat to himself or his father. Often people with the current presentation, clinical history and violence of James have a higher potential to assault others especially family members, which further tends to alienate them from their remaining family support (Douglas et al., 2009). Conclusion Rogers (2000) warns that risk only evaluations are inherently inaccurate (p598), which may have consequences on the client by labelling the client as violent. We must also work towards a standardised definition of risk assessment. The New Zealand Mental Health Commission (1998) defines risk assessment as a risk to the progression of symptoms of the illness, risk of the individual intentionally self-harming, the risk of self-harm that was not done intentionally and the risk of causing harm to others either by intent or as a result of risk taking behaviours. Crowe (2003), raises the issue of the need for a more specific defining of risk in the context of risk assessment and risk management. The debate in between health professionals as to whether clinical or actuarial assessment provides a higher level or risk assessment and hence reduces the risk of harm to others as well as the patient continues to be debated. Doyle et al., (2002), reports that although actuarial assessments is shown as statistically superior to unstructured risk assessment techniques, actuarial assessment focuses on static factors and misses dynamic factors such as treatment non-compliance, family dynamics, poor impulse control and substance abuse. Rogers (2000), reports that parents who are more accepting and hence understanding of the patients mental illness has been found to be a strong protective factor to assist the patient. There appears to be a need for further research to develop a more integrated approach to risk assessment to ensure a more standardised process is implemented. The risk management of violent behaviours is a complex process and requires a multidisciplinary approach that needs to focus on social, psychological and medical aspects of the individual (Howells, 1996). In the case of James, any risk management program must be approached from the broader perspective to achieve beneficial for James in the long term. Hilton et al., (2001), suggests that as demand for more valid risk assessment outcomes increase in relation to forensic mental health patients that actuarial assessment will be incorporated as an important part of the risk assessment process.

Letter to the reader Essay

To The Readers In my portfolio I will be writing about varies of things such as Georgia 411 Interest Inventory, My Career Choice, Autobiographical Incident Essay, and Persuasive Essay & Narrative Essay. In these essays you will get different types of emotions from me. Let me break down what it is that I will be writing about in the essays. First in my Georgia 411 Interest Inventory essay it’ll be about what type of learner am I? And what types of careers match your skills. Â  Secondly in my Career Choice essay I’ll be writing about a college/career dedicated to the future career I choose. The main point of this essay will be to research my career choice and create a plan of action including the amount of education required and prepare myself to be able to interview for the position in the future. Now my third essay is about an Autobiographical Incident that impacted my life in some way. How did the incident affect me? What were some thoughts during the experience? What are my thoughts on it now? This essay is something that means a lot to me because it impacted my life in so many ways. It was kind of hard trying to type up this paper without crying but it was well worth it in the end; because it brought back memories that I tried to forget. Fourthly, my essay is a Persuasive Essay it’ll be written to convince someone to adopt my beliefs on a topic. Â  Most of all lastly, my last essay is a Narrative Essay a fictional story of my very own. I do hope you all enjoy what I created in my portfolio.

I Heart Huckabees

‘Know thyself,’ said Socrates, Greek philosopher. His argument was we must know ‘thyself’ in order to be wise. As people grow up, they want to find out about themselves. Students, for example, think critically about what they want to become because adults say the thought of money equals happiness is wrong. Dr. Carl G. Jung states that, â€Å"one must get in touch with the Shadow and Anima/Animus before one can truly get in touch with Self. † The film, I love Huckabees, shows examples of existentialism and the process of finding one’s true self. Albert, Tom, and Brad were successful in dismantling and getting down to their true selves because they accept their shadow, polarize with others, and realize their persona. Albert Markovski is the protagonist who is the director of coalition called ‘Open Spaces. ’ He initially seeks the existential detectives, The Jaffes, to question the coincidental incidents with Steven. Through the process of dismantling with the Jaffes, Albert shows signs of his shadows such as jealousy, denial, and over-reaction. One’s shadow can be easily seen from a third-person point of view such as friends. Albert’s shadow is clearly shown when Bernard uses the body bag method. Jealousy, which is a sign of desire of love, is visualized in the image where Dawn says, â€Å"Stop looking at me. † Albert’s denial and over-reaction is clearly shown when Brad, Albert’s shadow, first visits the Jaffes with an objective of getting Albert fired. With unsatisfactory results from the Jaffes, Albert follows Tom and meets Catherine, student of Jaffes. Catherine identifies that Albert’s reasoning for feeling embarrassed for sadness is derived from his mother. Catherine says, â€Å"You were orphaned by indifference. † After realizing his true self, liar, he accepts and follows Catherine’s philosophy. However, he realizes that the Jaffes philosophy and Catherine’s philosophy are polarizing ideas. Through those ideas, he accepts his shadows; when he derives that him and Brad are the same and desire for love through experiencing sex with Catherine. Catherine also teaches the feeling of ‘pure being’ which is being in a state of empty thought. There are many claims and theories that emptying one’s mind can get close to one’s spiritual self such as Anima/Animus. Albert loves the feeling of ‘pure being’ state, but there is not enough information to explain if this progress is finding his spiritual self. Tom Corn is a fire fighter who is obsessed with petroleum. Due to his obsession, his wife leaves him along with his daughter. He also meets both philosophers but he mainly focuses in Catherine’s philosophy of nihilism. His success in dismantling was from the event where he saves Dawn in the burning house and falls in love with her. This attraction is because they are two opposite extremes. For instance, Tom is an aggressive type of person whereas Dawn is very positive type of person. Tom and Dawn show their successful dismantling when Dawn breaks up with Brad. It proves that Tom and Dawn trust each other which are derived from their honesty. Their relationship also shows Tom’s acceptance towards his desire for love in which he denies with rage when he sees Albert and Catherine having sex together. Although Tom needs improvement on finding his true self, his relationship with Dawn is the perfect condition which requires trust, honesty, and commitment, to help each other identify their shadow. Unlike Albert and Tom, Brad Stand is less successful in finding his true self. He only cares about other people’s opinions or rather, the society’s standard. He meets the Jaffes and does not take them seriously at all and in fact uses them to get Albert fired. His dismantling is successful when Vivian brings the recording of him repeatedly telling the story about the chicken salad and Shania. The Jaffes point out that Brad is doing this just to keep him cheerful. Brad refuses and states that he will stop telling the story. He does manage to not say the story when the corporate board of directors asks to tell the story but instead, ends up vomiting. Another significant event for Brad is when Albert burns down Brad’s house. Brad starts to question his existence just like Albert has. Although this event is nothing like his shadow, it is significant because for a person who barricades behind their mask, questioning one’s existence is a successful start. He accepts the fact that he needs help from someone when he mentions, â€Å"Yeah, okay, I’m caught up in that shit† inside the elevator with Albert. Albert suggests him to meet Catherine. Hence, Brad heads to the right direction to finding his true self. Through all the insane events that identified one’s shadow, polarization, and persona, Albert, Tom, and Brad dashes through to their true selves. Although Brad had hard time finding the starting line, Albert comes to help by burning off Brad’s mask that was blinding him. ‘Life is like a long marathon, you can’t stop, but to keep going. ’

Victims Of The New Victims - 940 Words

As stated in Ministry of Justice (2013) press release victims of crime will receive more support than ever before to help bring offenders to justice and move on with their lives. The new Victims’ Code was set up explaining that people should expect from criminal justice agencies from the moment of reporting the crime to the end of trial. According to the Code victims of the most serious crimes, including hate crime, domestic violence, terrorism and sexual offences should get access to services like pre-trial therapy and counselling. There are free support and advice are available for victims of all crimes from Victims’ Information Service. The victim of crime has the right to contact the police and be kept informed about the investigation. During the investigation the police give the victim an update on the case at least once a month until it is closed. The police will let the victim know within 5 days if someone is arrested, charged, set free etc. Also, the police have to inform the victim if they cannot investigate the crime and explain why they have dropped this investigation. After finishing the investigation, the police pass it to Crown Prosecution Service (CPS). CPR decides if there is enough evidence to take the case to court. If the charge is altered or dropped, the victim would be informed and have a legal right to request the review of CPS decision. The victim have right to provide to the police a ‘victim personal statement’, telling how the crime has affectedShow MoreRelatedA New Deal For Victims And Witnesses Essay1386 Words   |  6 PagesThe role of victim in the United Kingdom has been debated throughout history. Historically victims contributed in an engaging part in contrast to their contemporary passive role within the criminal justice system. 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