How effective are the current risk assessment tools within a community based mental health setting?
Introduction
Patients who have mental illness are particularly underprivileged by the fact that they get to experience unpleasant symptoms (Bolton et al. 2014). Again, they have experienced a higher risk of harming themselves, plus others who care for them. With that, healthcare institutions put up tools to aid mitigate risks that arise from patients with mental health. For instance, depression is a condition positively associated with augmented suicide risks and similarly leads to self-neglect and self-harm. The significance of improving well-being and mental health is stressed on the immediate policy goals of the UK (Garland, Bickman, and Chorpita 2010,p.15). Risk assessments related to psychological problems is increasingly noted as the primary component within the mental care. The current policy in UK medical practices louds it as the best practice with practical tools used in caring for the patients. Primary care plays an essential role in risk detection. Averagely, a patient with a severe mental problem is assigned 24-15 consultants by their general practitioner annually. (Garland et al. 2013,p.8).Even though multiple academicians and researchers have studied the deliverance of mental healthcare within general practices, the critical thing which remains unknown is how effective the tools are used on mental health care patients. Little is known about the effectiveness of these tools (Singh, Grann, and Fazel 2011).
The available evidence in the UK illustrates that risk assessment for tools used for mental care varies considerably. The pattern is replicated within states in the USA (Orlowski et al. 2019). Nurses perform huge roles in risk assessment of such tools. They depend on experience and intuition instead of recognized tools for treatment (Lofthouse et al. 2017). The net outcome is that information about risk is rarely gathered or recorded systematically. Besides, there is resistance to standardization practices.
What is more, an agreement concerning risks between primary care and secondary care involves clinicians identifying the poor, outlining the needs for improvements as well as working collaboration for various sectors of healthcare (Settipani et al. 2019). Ideally, there is insufficient risk assessment for the tools used on mental health patients in community-based care. Currently, the landscape of primary mental healthcare in the UK has transformed considerably. This has been triggered by the enactment of IAPT services (Berry et al. 2019). On the recommendation of NICE, the initiative is aiming to enhance mental health by offering psychological therapies like counseling and cognitive and behavioral treatments to the persons who are suffering from problems related to mental health issues (Rotter and Rosenfeld 2018). The services of IAPT offer clinicians with direct access to patients who are mentally ill. These persons are at risk. Thus, comprehending the process of risk assessment in these services and attempting to strengthen various practices is imperative whenever the risk has adverse outcomes, which are utterly avoided by a more significant number of patients (Scott et al. 2018).
Most of the studies on risk assessment of primary are put more focus on suicide tendencies. These researches consistently emphasize the need for improving the efficiency of various tools that have been put on place to treat mentally ill patients. There is a need to enhance mechanisms for suicide detection materials. A study done by Marchette et al. (2019) indicates that patients and general practitioners and patients have various perspectives on screening related to suicide. The research established that most of the GP often lack confidence when it comes to evaluating risks (Skellern, Hutchinson, and Dunn, 2016). There are perceived barriers in suicide screening like differences in cultural and language issues, the limited timeframe in consultation, concerns regarding impact assessments, and others. Patients show support to various tools used in screening in hospitals (Keet et al. 2019). However, the perceived barriers with the tools for risk assessment make healthcare practitioners find it hard when it comes to assisting patients with mental illness.
Literature Search
Strategy for the search
The strategy for the search followed the research topic. The keywords used for the search were selected through the use of PICO frameworks (Speckman and Friedly 2019). The search terms were identified via population, intervention, comparator, and outcomes of the study. For example, the people under review were people with mental health. All the keyword regarding mental challenges were filtered and assessed. Words related to psychological problems like suicide, anxiety, depression, and others were recorded under this scenario (Kloda, Boruff, and Cavalcante, 2020). Mental health ailments search led to the various tools which assist I the risk assessment of problems psychological issues. During the search, subgroups of mental health persons were considered, which led to the discovery of other terms(Salvador-Carulla, Lukersmith, and Sullivan 2017). The intervention approaches aided in the realization of the accuracy of tools employed within the community-based treatment. As indicated by Kane, Evans, and Shokraneh (2018), many healthcare-related databases need to be thoroughly searched to come up with appropriate information regarding the area of study. Thus, for this essay, the writer employed electronic databases like CINAHL Complete, Medline, Academic Search Complete, Psycarticles, Psycinfo through the EBSCOhost portal, and PubMed to attain suitable articles under study (Nilsen et al. 2019). Similarly, the writer garnered some information from non-academic databases, including the National Institute for Clinical Excellence as well as Google.
Inclusion and exclusion criteria
Determining inclusion and exclusion criteria for any participant undertaking a study should be standard. It is the required practice whenever one is learning the protocols of high-quality research. Zimmerman, Balling, Chelminski, and Dalrymple (2020) define inclusion criteria as significant features of the population that is targeted for the study. These features are the ones used in giving answers in any research question formed for the study. Inclusion criteria incorporate clinical, demographic, as well as geographic features (Amundsen et al. 2018). Contrastingly, exclusion criteria refer to characteristics of prospective participants in the study who attain the inclusion criteria though presenting added features that might interfere with the study success. At times, the risks of these participants might portray unfavorable outcomes. The standard rules for inclusion incorporate desirable features of individuals, making them possible to be followed closely, offer appropriate data, miss appointments scheduled for data collection purposes as well as pose comorbidities, which could lead to bias in the study results. At times such participants have the capability of increasing the risks of unfortunate events whenever one conducts a study and include them( Demaerschalk et al. 2016). The writer did not only describe the appropriate criteria for inclusion and exclusion but similarly assessed how such decisions shall have impacts on the result validity externally.
The writer utilized the PICO framework to assist in giving guidance on inclusion and exclusion criteria. The limiters employed in retrieving acceptable articles included a systematic review and randomized control trials (Gartlehner at al 2017). All the articles which were published before 2010 were excluded for the search. On getting the needed article, the writer perused the abstract offered on every paper to ascertain its relevancy to the topic selected for the study. The final six articles were chosen with their relevancy to the study topic. Other elements, including the integrity and credibility of the information, were evaluated by the writer for all the articles chosen.
Literature Critique
Article #1
A systemic review by Bunn et al., (2014), appraised fall prevention interventions in older psychiatric patients mainly in inpatient settings; however, all parameters were inclusive. A fall is the primary cause of mortality and morbidity for elderly persons. The risk of falling is related to the mental health problem one might have. Past reviews have concentrated on individuals having dementia as well as cognitive impairment. However, various tools used in the mental health setting have been left. This study aims to assess the effectiveness of fall prevention devices in support of older individuals having meaning challenges being cared for in a various environment of mental health. Studies were examined for fall prevention interventions in mental health patients 60 years of age and older. All but one of 21 studies was published between 2004 and 2014 (Bunn et al. 2014). The article reviewed four uncontrolled and seventeen randomized studies with eight being cluster and nine individual RCTs. Interventions discussed were widely varied in older patients with mental health and cognitive disorders.
The risk assessment included sensory mediations, patient education, and supervision, environmental manipulation, and exercise. Fall reduction related to presented interventions was inconsistent. The article concluded that there is a lack of evidence to suggest provisions for fall risk care in older mental health populations with psychiatric illness. The research indicates that further investigation regarding elements of multifactorial interventions is needed (Bunn et al. .2014). This systematic review is a level I hierarchy of evidence. All the participants employed for this study were the elderly having mental problems. The major indicated in the survey, people with mental challenges, experience challenges associated with depression, dementia, and psychosis. The study lacked a particular focus on specific mental health problems to be incorporated. However, as long as a significant proportion of participants reported a psychological problem, then their data were separately reported as those having mental conditions. Even though preliminary studies show that there were insufficient controlled studies under this area, as demonstrated by the authors, the critical interest was the number of participants who are sustaining falls during the study as well as associated data to the fall numbers available for the review. Even though the Bun et al. (2014) outlined multiple outcomes of falls by the elderly persons having mental challenges, the article fails to provide reliable measures that can be used in preventing difficulties outlined.
Article #2
Narayanan et al. (2016) outline ways in which care for older people can be improved within mental health settings. The authors evaluated the effectiveness of risk assessment tools that are adopted by NHS mental health trust in England as well as Wales healthcare board. Narayanan et al. (2016) carry an evaluation of various comprehensive tools and predict their validity and effectiveness to assist in handling care within the mental health setting. The study uses a sample of 56 participants invited from NHS mental health trust from England as another 6 participants are drawn from the healthcare board in Wales. The participants got an invitation to provide their policies pertinent documentation of tools used in the prevention of falls among the people with mental health. To inspect the effectiveness of listed tools within policy documents, the variables of risks related to each device adopted by NHS were matched with those of 2004 NICE guidelines on averting falls. A thorough analysis of the literature review was performed to assess the validity and effectiveness of tools used in mental health settings. The policies on falls were acquired from 46 NHS trusts. Among the obtained systems, 35 met the criteria for inclusion and were incorporated within the analysis. The primary assessment tools for fall evaluation used included MFS, FRAT, and STATIFY (Narayanan et al. 2016). These tools have been validated to be used in treating falls among the elderly within mental health settings. However, the study failed to establish their effectiveness in handling other problems of which might be experienced among the people with mental challenges. The authors outlined the inconsistency of the predictive validity of all the tools. It was established that none of these tools had been validated to be used in various mental health settings, hence have risks concerning effectiveness.
Risk assessment on falls is a majorly employed element of risk prevention approaches. However, various policies available include tools which are not valid thus not useful in operation. The validated tools like MFS and STRATIFY have inconsistency when it comes to predicting accuracies (Narayanan et al. 2016). This has raised multiple queries concerning the use of such tools in operations. None of these tools passed the test of acute treatments within the settings of mental health. Risk assessment tool four mental health trust gave all the need requirements of the NICE guidelines. The multifactorial assessment was done on falls preventions. The current guidelines of NICE require that tools for forecasting risks using numerical scales must not be employed. Nevertheless, evaluation of multifactorial risks and interventions tailored to patients is essential. Thus NHS should do regular updates on policies about the present guidelines outlined by the NICE.
Article #3
Edmonson, Robinson, & Hughes (2010) performed an extensive search of systematic reviews to establish the content validity of developing psychiatric risk evaluation tools used to treat falls among the mental health persons. After development, the instrument was examined by an expert and panel and applied to a retrospective chart review. The authors reviewed 50 inpatients of mental health suffering fall tendencies. Besides, global sample units of charts for over 298 days ware studied. Each measurement was weighed using multi-dimensional scaling. Nurse perceptions of usability were obtained through an online questionnaire. A cross-sectional sectional study applied simultaneously with the MFT showed that EFRAT was more sensitive towards predicting risks for acutely ill mental patients. The article advises further testing of the EFRAT for validity and reliability (Edmonson, Robinson, & Hughes 2010). The expert opinion and cross-sectional used within this study make it be a hierarchy of evidence level V.
Article #4
The evidence summary by Slade, Ther, and Ther (2015) evaluate the best available evidence referencing risk assessment tools within a mental health setting for the inpatients with fall tendencies. Knowledge gained was from two cross-sectional studies and a review of fall policies from 46 United Kingdom mental health trusts. The summary concludes that validated tools measuring fall risk factors unique to the mental health populations are optimal for patient assessment on the inpatient psychiatric unit. The article is advising further testing for assessment validation in mental health patients. From the report, the researchers have outlined various measures needed to take to validate the effectiveness of tools for the treatments of mental health patients (Slade, Ther, and Ther 2015).
Article #5
This study by Xu et al. (2012) is a systematic review of quantitative studies assessing the effectiveness of risk assessment tools used in monitoring falls for acute adult mental health environment. This study illustrates that falls risk evaluation, particularly for patients with mental health, is essential for early identification and implementation of preventive measures. Eleven quantitative studies included in this review concluded particular risk elements were more related to adult mentally ill patients. However, there were too few studies to find sufficient evidence related to risk assessment tools as well as strategies for averting falls within the mental health environment (Xu et al., 2012). It is recommended that continued observations will serve healthcare professionals in identifying psychiatric patients fall risk factors (Xu et al., 2012). This systematic review provides a hierarchy of evidence equivalent to the level I.
Article #6
Every year, 700,000 to one million individuals within the United States often fall while in care institutions (Vasconcelos Barbosa Borba Pontual 2017). About 35 percent of those who fall get injures as 20 percent of the falls lead to traumatic injuries. Vasconcelos Barbosa Borba Pontual (2017), in his research, indicates that about a third of those falls which are experienced in mental health settings could be prevented when practical tools are put into use. The author presents a fall risk analysis tool used in most of the local community hospitals. Hendrich II fall risk model is a majorly used tool in various care hospitals for mentally ill patients. Despite these tools having been implemented for fall interventions, most of the hospitals are still experiencing several falls among the patients. Vasconcelos Barbosa Borba Pontual (2017) notes to occur as a result of the ineffectiveness of the tools which are used in these hospitals. The principal aim of the study was to establish whether RNs handling patients use various tools presented accurately. The study reviewed 106 patients to determine the current assessment tools used by medical professionals. The 106 patients were drawn to the hospitals and monitored for two months. The goal of this study makes readers comprehend whether nurses use tools given to appropriately not. The data attained were compared to the ones collected by the RNs. The collected data in the hospital showed that RNs are failing on the effective utilization of the available tools in the care system.
Research synthesis
The evidence outlined in this paper is systematic reviews in the two articles. A systematic review is a sampling of data collection producers using a prescribed protocol for the synthesis of evidence poised to answer a research question(Polit and Beck 2017, p.746). Article one addressed the usefulness of fall risk evaluation tool within general adults of the mental health populations. Again, the second article delved o the individual fall risk factors specific to mental health clients over the age of 60. The third item is an evidence summary examining both specific psychiatric risk factors as well as the utilization of fall assessment tools. Evidence summaries are short systematic reviews of an item similarly referred to as critically appraised topics (JoAnna Briggs Institute, as cited by Laureate International University (2017). Article four gives an examination of the construction a validity of a tool with the use of a retrospective design. This non-experimental, observational method seeks to link current phenomena to phenomena that have existed in the past (Polit and Beck, p.204). The last case studies a comprehensive analytical review designed towards evaluating the appropriateness of tools which are used in fall risk assessment. These tools are drawn from mental health setups. The tools must meet the standards and guidelines of NICE. The case studies, as per Polit and Beck, indicate that profound analysis tools used in any healthcare setting are imperative for effective service delivery. Thus, it is essential to the management of healthcare facilities to put into use practical tools for treating ailments cropping up to contain the spread of diseases. Effectiveness of tools used in the care process is essential because, in most cases, accurate results are needed for any treatment administered. However, with tools offering invalid and inaccurate results would show that inappropriate treatment would be provided to the patients.
Conclusion
The literature critique posed a challenge, particularly in finding relevant material due to limited availability of evidence on the topic of risk assessment in mental health environments. The use of appropriate key terms was crucial in accessing proper research. In an attempt to provide the answer to the PICOT question ‘how effective are the current risk assessment tools within a community based mental health setting?’ the result is the need for continued research. The evidence leads to the probability that a tool tailored to specific risks related to psychiatric patients can provide a better assessment that may result in fewer falls. The evidence weighs heavily that evaluation criterion for mental health patients is unique to the patient population
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