Assessing the mental health needs of older people

Assessing risk


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.

Ideas from practice

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:

<Negligence____Risk management_____Over-protection>

'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:

Staff are expected to:


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.

Case example

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