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Moving towards Individualised Risk Management

by | Jun 3, 2024

Moving towards Individualised Risk Management: The NICE clinical guidance on self-harm, updated in 2022, brought a significant shift in approach to risk assessment and management.

Once considered essential for predicting suicide or self-harm repetition, risk assessment tools, scales, and levels are now discouraged, and guidance recommends against their use for:

a) predicting suicide or self-harm repetition, and

b) making decisions about treatment or discharge.

This change aligns with the Suicide Prevention Strategy for England 2023-28, published last year. All services have been urged to reassess their use of these tools and scales, and to transition towards an individualised approach to risk assessment and management.

Moving Towards Individualised Risk Management on an tablet screen

To support you and your team in meeting the updated NICE clinical guidance (NG225), we’ve developed a resource titled, ‘Moving Towards Individualised Risk Management’.

In this blog;

In this blog, we’ll explore how the NICE guidance and National Strategy combined have spurred services into action. Some of this action has involved both our Director Keith Waters, and our CEO Bianca Romanyk. They have both recently been invited (separately) to present on this topic. 

Keith’s presentation came first, and his approach to the task was clear: he wanted to understand and explain the development of risk assessment tools and scales, with a focus on where they had come from, why they were used, and – most importantly – what had changed.

What did we learn from the literature review?  

At Storm Skills Training, we want everything we produce to be linked to evidence, best practice, and lived experience, as these are core elements of our values.

A comprehensive literature review was my first step, to lay the foundation for Keith’s presentation and develop our understanding of the topic.

Historically, approaches to risk assessment across a range of human behaviours (including self-harm and suicide) have been primarily focused on prediction.

Knowing which service users would go on to repeat self-harm or take their own life allows professionals to intervene.

However, traditional approaches to self-harm and suicide risk assessment involve making decisions about risk based on professional judgment.

This approach drew criticism for its subjectivity, since decisions about treatment and care were effectively driven by opinion, intuition, or “gut feeling”.

There was also increasing evidence to suggest that professionals’ predictions about risk of future self-harm or suicide were largely inaccurate.

All of these factors combined paved the way for risk assessment tools and scales to emerge as a solution, since they seemingly removed subjectivity from the assessment process and used available evidence to improve practice. These tools offered some tangible benefits, such as providing a structured framework for the assessment process and offering an “aide memoire” for clinicians, especially those with less experience.

Despite our best efforts and intentions, however, evidence has consistently revealed the inherent limitations of trying to predicting suicide, either with or without tools. Put simply, we can’t predict who will end their life. This is because suicide is both complex and relatively rare, and risk of suicide is dynamic. The 2024 annual report from the National Confidential Inquiry into Suicide Safety in Mental Health (NCISH) strikingly revealed that 82% of patients who were in contact with services before their death by suicide were judged to be “low” or “no risk”.

This underscores the need for an alternative approach. Until recently, however, the alternative has not always been obvious.

There’s a lot of information and evidence out there, but sifting through it takes time and not all of it is accessible or practically oriented. Along with the support of the Storm Skills Training team, I’ve taken the time to do the work for you – view the resource here.

Keith’s presentation and the resource received a positive response from a group of specialist mental health professionals, they found understanding the history and changes over time helped to understand the reasons and need for the guidelines, and it sparked conversations about its benefits for other team members in different departments and roles.

If you’re interested in learning more, our CEO Bianca presented at the National Suicide Prevention Alliance (NSPA) members’ webinar titled “Best Practice in Assessment of Suicide Risk” on May 28, 2024. This event focused on exploring effective practices in using risk assessments to support individuals experiencing suicidality. The webinar also featured Philip Pirie, a bereaved father advocating for suicide risk assessment reform, and NSPA Lived Experience Influencer Andy Willis. We will share the recording with you as soon as it becomes available. View the resource: Moving Towards Individualised Risk Management.

Reflections

Recognising the limits of traditional predictive approaches has been sobering, but the shift towards a more individualised and compassionate model signals a positive change that is long overdue. This shift isn’t just about changing processes; it’s about fostering a culture of empathy – one which focuses less on predicting risk and more on promoting safety and meeting individual needs.

Moving forward, we’re committed to providing more evidence-based resources for the self-harm and suicide prevention community. Your input is really valuable in helping us to tailor this content and provide resources that are practical and relevant. Whether it’s risk management, therapeutic intervention, or a topic that you feel needs more attention, please do get in touch with me at becky@stormskillstraining.com to share your ideas and suggestions. 

References

View list of references for this blog

 

Linda's Story:

Meet Linda Gask: Co-founder

I studied medicine in Edinburgh, before moving to Manchester where I trained in psychiatry. I had both professional and personal interest in mental health, having experienced depression and anxiety myself. I was acutely aware of the need for effective communication to better understand and work with my patients.

Storm Skills Training started as a research project Manchester University funded by the Department of Health in the 1990s. Myself and Richard Morriss developed a training package that demonstrated how using viewing recorded roleplays could actually change people’s behaviour. We first tested our approach in Preston, then across a wider area in South Lancashire.

At that point, we named it Storm Skills Training and we were joined by Gill Green to roll out the delivery of training. Gill further developed Storm as a CIC and it’s wonderful to see how it has grown to where it is today under Bianca and her team.

My passion for many years has been on making mental health support more accessible in primary care. Until the Spring of 2023, I was Presidential lead for primary care at the Royal College of Psychiatrists and I continue to offer advice on the issue.

I moved to Orkney full time in 2020 at the start of the pandemic. I am Chair of a local mental health organisation called the Bilde Trust. As a rural community, we face our own challenges with mental health – it’s great to be involved in making a difference where I live.

Orkney is a wonderful place, unlike anywhere else in Scotland or the UK. I particularly enjoy writing here. After my first book, The Other Side of Silence, was published, I wrote my second (Finding True North) about how moving here positively impacted my own mental health.

My third book will be published at the end of 2024, exploring mental health and feminism. Maybe then I will take it easy, but that’s very hard for me to do!

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A not-for-profit social enterprise delivering high-quality skills training in self-harm and suicide prevention.

Keith's Story

Meet Keith Waters: Non-executive Director

Keith has over 25 years of clinical experience in Liaison psychiatry, self-harm and suicide prevention and was awarded an Honorary Research Fellowship by Derbyshire Healthcare Foundation Trust (DHCFT) in 2013.

For many years he was the lead for the Derby site of the Multicentre Study of self-harm in England, a study which he still maintains a very active role in. Until recently he was the Clinical director for self-harm and suicide prevention for the Trust and retains a post within the research team.

Keith is also a Storm Skills Training consultant with many years experience in facilitating, delivering, and supporting Storm Skills Training and has for a number of years held a seat on the National Suicide Prevention Alliance steering group.

He has been the Suicide Prevention manager for the East Midlands and Clinical Advisor for Suicide Prevention with the East Midlands Academic Health Science Network, developed a business and clinical case for Liaison Psychiatry Services in Derbyshire, and was the clinical advisor for its implementation.

Keith is an experienced trainer, facilitator, and presenter in Self Harm and Suicide prevention and management, locally and nationally in addition to the work with DHCFT and Storm Skills Training, has helped develop and delivered an initially lottery-funded suicide awareness training program across the East Midlands and organised chaired and delivered at numerous nation conferences and events. Keith has also been a joint author on numerous published research works, and chapters in clinical textbooks on self-harm and suicide prevention and has contributed to policy and practice guidance developments locally and nationally.

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Alf's Story

Meet Alf Hill: Non-executive Director

I first encountered Storm Skills Training CIC during my time as a volunteer Business Mentor at Unltd – a charity that supports social enterprises. Co-founder Gill Green was one my mentees in 2010 when Storm Skills Training was still within the University of Manchester and at the beginning of its journey to becoming an independent Community Interest Company.

At our first meeting I asked Gill, “How do you think I can help you?” Gill’s response was “Well… you could explain accounting to me.” We worked together for 18 months to develop Storm Skills Training as a social business. When Storm Skills Training CIC was finally incorporated in 2011, I was invited by Gill and Linda to be a non-executive Director and became Chair of the Board ten years later in 2021.

I’ve had a diverse career; initially as a civil servant, then in senior management and executive and non-executive roles in insurance and reinsurance in the UK and USA, in the corporate sector, and in Lloyd’s of London.

I returned to the public sector initially in adult education then at the Equal Opportunities Commission, later the Equality and Human Rights Commission.

A qualified accountant, I’ve been trustee of several charities, local and national, currently the Yapp Charitable Trust and the Centre for Investigative Journalism.

At Storm Skills Training, post-pandemic I feel that we are stronger than ever. I’m excited about the future with our new team with an ambitious plan.

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Gill's Story

Meet Gill Green: Co-founder

My career has taken me from nursing to academic research and finally to the development of Storm Skills Training CIC as a skills training company.

When I was nursing, so many of my patients often expressed that they felt so hopeless that they thought about ending their life. And like so many of my colleagues, I felt ill-equipped to know the right way to respond. It was a dilemma that I wanted to address through skills training – to give fellow healthcare professionals the confidence and practice they needed to have those difficult conversations.

In 1997, it was a chance job advertisement in a national paper for a Trainer and Researcher that introduced me to Storm Skills Training. At the time, I saw the 12-month project, working with Linda Gask at the University of Manchester, as an opportunity to learn new skills to take back to clinical practice. After the project, I stepped away for a few years, remaining in research but working with prisons on a different project. Research was definitely where I wanted to be.

I came back to the University of Manchester in 2003, when Linda and I started to develop the training package we now know as Storm Skills Training. It was important to us to translate the theory into usable, effective practice. I knew that as a healthcare practitioner, it wouldn’t be enough to sit in a room and be ‘taught’ suicide prevention. It is only through practice that we can actually ‘do’ suicide prevention.

I’m looking forward to supporting Bianca in realising her vision for where we go to next – and to exploring even more new directions for my own career. 

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Bianca's Story

Meet Bianca Romanyk: CEO

After 20 years in the mental health field, I am incredibly proud to be CEO of Storm Skills Training.

In my early career as a probationary psychologist working in community mental health, I can remember thinking that I’d like to one day have a role that could influence and impact the lives of many who were in distress. I recall meeting the CEO of the mental health service and being inspired by her and the compassion and empathy she showed those experiencing mental health issues.

Being in a small town in rural Australia I had the privilege of my role spanning across several areas of mental health, including working in an ongoing way with people with severe mental illness and crisis assessment (and being on call). I enjoyed all of it - I loved working with people, building trusting relationships, and working alongside them. I developed a special interest in working with younger adults with complex trauma and was lucky enough to train and be part of the Dialectical Behavioural Team for a short while. All of these experiences in my early career have driven my passion to make a difference for those in distress. I believe it is the quality of the connection that we make with people that makes a difference.

My career took me away from the frontline but rooted deeply in mental health and creating positive change. I found myself sat in a Storm Skills Training session as a trainee facilitator in 2013, Gill was delivering the course. I’d started in a brand-new role, working with schools in Australia to support their communities impacted by suicide. I recall vividly the anxiety of being on film in front of my new colleagues and the relief, value, and benefit the experience gave me. I left the training session feeling so empowered – I knew this course would help teachers and others working in schools to have conversations that made a difference to young people in significant distress. I wanted everyone to have Storm Skills Training!

Life presented itself with an opportunity to move to the UK. In 2014, before I left, Gill returned to Australia, we agreed to meet and talk about the opportunity to work together when I arrived. I arrived in the UK, with my two dogs, on the 7th of August 2015 and started work with Storm Skills Training on World Suicide Prevention Day the next month.

I haven’t looked back, my life here in the UK is lovely! When I’m not working, you’ll find me on my local common with my dogs, Derek and Doris, enjoying the view and nature. Or in my garden having a chat to the plants. I enjoy all things creative. More recently I have become a foster carer and am looking forward to this new life challenge and making a difference to the lives of young people.

I love the Storm Skills Training team, our consultants, and community and am always thinking about how to build and improve on the work we do, to have a positive impact on the world. I know that between us all we can make a real difference to people in distress. That’s what I am most excited about.

I believe passionately that Storm Skills Training helps to save lives. My vision for the future of Storm Skills Training, and our community, is to strive toward a more collaborative, empowering, and person-centred approach to self-harm and suicide prevention. A world where distress is met with compassion, everyone feels empowered to help and the support offered is tailored to the unique needs of people and their stories.

 

 

 

 

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Find support:

If you need help and support please reach out for it, here are some options:

Samaritans (UK)

Email: jo@samaritans.org

Phone: 116 123 (24 hours a day, 365 days a year)

Visit: samaritans.org

International Association for Suicide Prevention (International)

Visit: findahelpline.com/i/iasp