Risk assessment is a process used in a variety of different industries to solve problems.  It involves three-steps including identification, assessment and control.  I have worked and lectured in two very different areas of practice where risk assessment is used, but it is implemented very differently.  Manual handling is one and mental health is the other.  In manual handling we use it in one way but in mental health we use it in two ways.  Can the way we use risk assessment is mental health help us make some gains in manual handling?

The problem

One of the problems I see in manual handling is that things are safe but they are not necessarily easy.  This can make things really hard for the care worker and the client.  As a health professional assessing this, I see many missed opportunities to make things easier because we have not aimed beyond safety, that is efficient and easier.  However, one of the problems with trying to make things easier beyond this marker of safety is the fear that they will move into territory where it starts to be dangerous or unsafe again.

How is risk assessment used in mental health?

I used to work on a mental health team here in Sydney.  Our team would cover the emergency department where people who were experiencing crisis, that is thoughts of harming themselves or others, would present.  When people who came into emergency with suicidal ideation, we would use risk assessment to make an assessment of that person.  Our aim during that assessment was to get someone from a state of danger to a state of safety.  This would involve an involuntary admission to hospital sometimes under the Mental Health Act or the person would be discharged into the community again but with support from our team.  The ultimate aim was to preserve life and move someone from a state of danger to safety.

From danger to safety

After the person was discharged home, our team would support them that evening in the community and the next day in terms of home visits or phone to help them plan remaining safe.  Our ultimate aim was to still move the person from a state of danger to a state of safety.  After a few days the person would reach a stage where they would be able to manage their own safety themselves.

From safety to life

At the stage it was determined that the person was safe, our team was no longer needed but we didn’t stop there.   Our team would then refer the person to another team.  This second team has a different aim.  Now that safety was achieved, they were focused on assisting the person to move from safety to life.  This is where risk assessment would be used the opposite way, to start taking risks.

Risk Assessment in manual handling

So how does this apply to manual handling?  In manual handling we are very good at making things safe but they are not always efficient.  Our interventions sometimes help the situation move from a state of danger to a state of safety.  Safety is quite a low measure and there are opportunities we could be missing to make things easier.

Risk identification	Risk assessment	Risk control
		Divergent thinking	Convergent thinking

Figure 1:  Creative Risk Management

To help us do this I have developed a framework called creative risk management.  It has four steps – risk identification, risk assessment, divergent thinking and convergent thinking (risk control).  The only difference between this and regular risk assessment is a stage of exploration of ideas before we look at controlling the risk.

Research has found that equipment solutions solve manual handling problems.  Equipment therefore can make things safe.  I have been teaching health professionals for over ten years on how to prescribe equipment and I constantly see equipment solutions in place where they are not being used to their full potential.  We are therefore getting to safety and stopping there.  We are missing simple opportunities to avoid manual handling.

Much of the anxiety of moving to the next level from safety to life is confidence in what the equipment can do.  I see creative risk management as a learning tool to help gain confidence with what equipment can achieve and how.  I propose we start using this or models such as this in continuing professional development training events to start creatively exploring the equipment we use.  Once have explored and know our equipment well and robustly, we can start to implement some of our learning with our clients to achieve safe and efficient manual handling routines.

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