The use of discharge risk assessment tools in general psychiatric services in the UK

Closure of asylums dismantled a system of risk control based on containment, resulting in a rise in homicides and suicides by discharged patients. Remedial action centred on a structured approach to managing multidisciplinary care (the Care Programme Approach) and a system of independent inquiries into homicides. A need for better discharge risk assessment was identified by government and health professions. The literature points to inherent limitations in the predictive power of actuarially based tools, restricting them to augmenting clinical judgement. This paper addresses the development and effective use of tools to predict risk to patients and public following discharge into the community. Methods used were: (i) a questionnaire to NHS Trusts in the UK; (ii) an analysis of documentation on tools in use; and (iii) interviews of hospital and community mental health teams at eight NHS Trusts. Findings point to: (i) a sporadic development of risk assessment tools at Trust level; (ii) that this has been stimulated by clinical governance but is unguided by any coherent national strategy; and (iii) that information technology for risk data collection is not well used in the UK, where there is reliance on use of paper records and informal communication. The implications for management and health professions are discussed.