Assessing the mental health needs of older people
Worry about risk and danger permeates assessment work with older people. Relatives, neighbours, the public and involved professionals all experience and react to this worry. The Department of Health's consultation on the Green Paper Independence, Well-being and Choice suggests that service users believe that professionals are too concerned about risk, and that this gets in the way of enabling service users to do what they want to do. The promotion of a person-centred approach aims to maximise independence and minimise risk, and often involves identifying and helping to resolve conflict and disagreement over risk and danger.
Hampshire Social Services Department's Vulnerable Adults Protection Policy provides an example of this type of approach.
Risk taking can be very positive. Objectives worth achieving for persons of any age involve the taking of risks, and the same principles apply to older people.
'Consider this continuum:
'On the one hand it is important not to neglect older people perceived to be at risk, but on the other hand it is equally important not to be over-protective. Somewhere in the middle lies the concept of risk management.
Hampshire's policy suggests the following framework for assessing and dealing with risk:
- 'What benefits do you hope to achieve with the older person (i.e. why is it worth taking a risk?)
- How will the benefit(s) enhance the older person's life, experience and/or dignity? How important do you (and the older person) rate the benefit(s)?
- What types of harm may occur while trying to achieve the above benefits, to the older person, to people known to the older person, to members of the public, and/or to property? Estimate how likely each type of harm is to occur. (Harm may mean physical harm, distress or embarrassment).
- What steps do you propose taking to minimise each type of harm? List each step relating to reducing the likelihood and the degree of harm.
- Who has been consulted about the risk decision? Have any major problems or disagreements been raised that have not been resolved? Describe the decisions made and action to be taken.
- Comment on how you propose to monitor the situation. What records will be kept and when will you review progress?'
Staff are expected to:
- 'Carefully weigh the possible risks against the ways in which an individual will benefit if they take the risk.
- Take everybody's views and feelings into account in making decisions.
- Discuss openly and clearly any differences of opinion.
- Make sure that older people and other key people such as friends, family, carers and advocates know how decisions have been reached.
- Make sure that the above individuals are involved as much as possible in managing and monitoring the risk.
- Arrange the support of an advocate when the individual needs independent help to express their views.'
It is important to have a management plan for dealing with identified risks, including a contingency plan in case things go wrong, and to communicate these to all who need to know.
When Mrs T, a widow with Alzheimer's, moved into a sheltered housing scheme in her village, she became disoriented and frequently got lost after going out to the shops. On several occasions she was brought back by strangers having been found walking along the main road away from the village. The warden of the sheltered housing scheme was very concerned about Mrs T's safety.
On the other hand, Mrs T had always been a very active, independent person and her family believed it was important for her to continue to go out on her own. They felt that in the village, where she had lived for many years, she was well known and would be relatively safe. They agreed a plan with the warden whereby neighbours would let her know if they saw Mrs T going out, so that the warden could keep a look out for her, and they made sure that Mrs T's name and address were in her handbag, in case she got lost.
Mrs T's family were willing to accept a degree of risk in order that their mother's quality of life could be maintained.
Next: Gathering information