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Care Programme Approach – documentation of past risk-related behaviour

  • Peter Dick (a1), Tessa Durham (a2), Mitchell Stewart (a2), Scott Kane (a2) and Jim Duffy (a2)...
Abstract
Aims and Method

The aim of the study was to assess the practicality of extracting past risk-related information from case records and to assess how this process might be cost-effectively incorporated in routine practice. Case records of 43 patients referred to the Care Programme Approach in Dundee were examined.

Results

Our study yielded relevant information – 39% of patients had a history of violence, 58% of self-harm or suicide, 58% of severe self-neglect and 72% of non-compliance with medication. However, it took an average of 5 hours to conduct a thorough review of each case because the notes were bulky and poorly organised.

Clinical Implications

Retrospective review of conventional case records in routine practice is likely to be incomplete and misleading. Prospective recording should be practicable if used selectively, but requires a standardised approach to clinical recording and case note maintenance. The risk recording system we developed, incorporating a dated index of incidents by risk category, followed by brief summaries of each incident, provides key clinical information not available from a simple check list while not sacrificing brevity.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Department of Health (1999) Safer Services. National Confidential Enquiry into Suicide and Homicide by People with Mental Illness. London: Department of Health.
Potts, J. (1995) Assessment and Management: a Home Office perspective. In Psychiatric Patient Violence Risk and Response (ed. Crichton, J.), pp. 3593. London: Duckworth.
Royal College of Psychiatrists (1996) Assessment and Clinical Management of Risk of Harm to Other People. Council Report CR53. London: Royal College of Psychiatrists.
Scottish Executive (2000) Report of the Mental Health Reference Group on Risk Management. Edinburgh: Stationery Office.
Scottish Office (1998) Implementing the Care Programme Approach. Social Work Services Inspectorate. Edinburgh: The Scottish Office Social Work Service Group.
Shaw, G. (2000) Assessing the risk of violence in patients. BMJ, 320, 1088–9.
Stein, B. (1998) A Survey of the Use of Scales and Checklists for Assessment of Risks in Mental Healthcare. Glasgow: Glasgow Caledonian University.
Taysideheal Thboard (1998) Dundee Mental Health Strategy – Dundee.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Care Programme Approach – documentation of past risk-related behaviour

  • Peter Dick (a1), Tessa Durham (a2), Mitchell Stewart (a2), Scott Kane (a2) and Jim Duffy (a2)...
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