There is more to risk and safety planning than dramatic risks: Mental health nurses’ risk assessment and safety‐management practice

TLDR

Risk assessment and safety planning are viewed as essential in mental health care, yet little is known about how nurses conceptualize risk and engage with these practices. The study aimed to examine mental health nurses’ practices and confidence regarding risk assessment and safety planning. A self‑completed survey of 381 Irish mental health nurses was used to gather data. Nurses mainly assessed suicide, self‑harm, substance abuse, and violence, focusing on self‑ and other‑risk while rarely considering iatrogenic or other‑risk; overall, they displayed limited recovery‑oriented practice, poor engagement in collaborative safety planning, insufficient attention to protective factors and positive risk‑taking, low confidence in involving families, indicating knowledge gaps that education could address.

Abstract

Abstract Risk assessment and safety planning are considered a cornerstone of mental health practice, yet limited research exists into how mental health nurses conceptualize ‘risk’ and how they engage with risk assessment and safety planning. The aim of the present study was to explore mental health nurses’ practices and confidence in risk assessment and safety planning. A self‐completed survey was administered to 381 mental health nurses in Ireland. The findings indicate that nurses focus on risk to self and risk to others, with the risk of suicide, self‐harm, substance abuse, and violence being most frequently assessed. Risk from others and ‘iatrogenic’ risk were less frequently considered. Overall, there was limited evidence of recovery‐oriented practice in relation to risk. The results demonstrate a lack of meaningful engagement with respect to collaborative safety planning, the identification and inclusion of protective factors, and the inclusion of positive risk‐taking opportunities. In addition, respondents report a lack of confidence working with positive risk taking and involving family/carers in the risk‐assessment and safety‐planning process. Gaps in knowledge about risk‐assessment and safety‐planning practice, which could be addressed through education, are identified, as are the implications of the findings for practice and research.