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Cues and knowledge structures used by mental-health professionals when making risk assessments
- Authors:
- BUCKINGHAM Christopher D., ADAMS Ann, MACE Chris
- Journal article citation:
- Journal of Mental Health, 17(3), June 2008, pp.299-314.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Research into mental-health risks has tended to focus on epidemiological approaches and to consider pieces of evidence in isolation. Less is known about the particular factors and their patterns of occurrence that influence clinicians' risk judgements in practice. This research aims to identify the cues used by clinicians to make risk judgements and to explore how these combine within clinicians' psychological representations of suicide, self-harm, self-neglect, and harm to others. Content analysis was applied to semi-structured interviews conducted with 46 practitioners from various mental-health disciplines, using mind maps to represent the hierarchical relationships of data and concepts. Most of the participants were from psychiatric nursing (21)and psychiatry (14), but social workers (3), general practitioners (3), and psychologists (3) were also represented. Strong consensus between experts meant their knowledge could be integrated into a single hierarchical structure for each risk. This revealed contrasting emphases between data and concepts underpinning risks, including: reflection and forethought for suicide; motivation for self-harm; situation and context for harm to others; and current presentation for self-neglect. Analysis of experts' risk-assessment knowledge identified influential cues and their relationships to risks. It can inform development of valid risk-screening decision support systems that combine actuarial evidence with clinical expertise.