WARRN – a formulation-based risk assessment process: its implementation and impact across a whole country
| DOI | https://doi.org/10.1108/JMHTEP-03-2019-0016 |
| Date | 24 October 2019 |
| Pages | 399-410 |
| Published date | 24 October 2019 |
| Author | Robert J. Snowden,Jordan Holt,Nicola Simkiss,Aimee Smith,Daniel Webb,Nicola S. Gray |
| Subject Matter | Health & social care,Mental health,Mental health education |
WARRN –a formulation-based risk
assessment process: its implementation
and impact across a whole country
Robert J. Snowden, Jordan Holt, Nicola Simkiss, Aimee Smith, Daniel Webb and
Nicola S. Gray
Abstract
Purpose –Wales Applied Risk Research Network (WARRN) is a formulation-based technique for the assessment
and management of serious risk (e.g. violence to others, suicide, etc.) for users of mental health services. It has
been gradually adopted as the risk evaluation and safety-planning technique for all seven health boards in Wales.
The purpose of this paper is to examine the opinions of WARRN as used within these health boards.
Design/methodology/approach –An online survey was disseminated to NHS clinicians in secondary
mental health services to evaluate their perceptions of the use and effectiveness of WARRN. Data from 486
clinicians were analysed with both quantitative and qualitative methods.
Findings –Results indicated that the overall impact of WARRN on secondary mental health care was very
positive, with clinicians reporting increased skills in the domains of clinical risk formulation, safety-planning
and communication, as well as increased confidence in their skills and abilities in these areas. Clinicians also
reported that the “common-language”created by having all NHS health boards in Wales using the same risk
assessment process facilitated the communication of safety-planning. Crucially, NHS staff believed that the
safety of service users and of the general public had increased due to the adoption of WARRN in their health
board and many believed that lives had been saved as a result.
Originality/value –WARRN is perceived to have improved clinical skills in risk assessment and safety-
planning across Wales and saved lives.
Keywords Suicide, Homicide, Formulation, Risk evaluation, Safety-planning
Paper type Research paper
1. Introduction
Risk evaluationand safety-planning are an essentialpart of mental health services.Accurate clinical
risk assessment and prevention/reduction of serious untoward incidents (SUIs), such as suicide
and serious violence toothers (including sexual violence), is crucial for the service users and their
family and carers, staff and the general public (Morgan, 2000). In this paper, we assess the
perceived effectiveness of a formulation-basedapproach to risk management (WalesApplied Risk
Research Network(WARRN)[1]) as it is used in clinical practiceacross the health boards in Wales.
1.1 Risk assessment in clinical practice
The Welsh Assembly Government’s (2010) Care Programme Approach states that a risk
assessment must be carried out for every service user who comes into contact with secondary
mental health services. Thus, risk assessments (and safety plans) must be usable and
interpretable by all qualified mental health staff (Webster et al., 2013). Many clinical risk
assessments, such as the HCR-20 (Douglas et al., 2014), are complex and involve extensive
training to use within mental health services (Morgan, 2000). It is not practical or cost-effective to
be able to train every mental health professional on the multitude of clinical risk assessments that
Received 20 March 2019
Revised 18 June 2019
Accepted 9 September 2019
Thanks to Phill Chick, Dave
Semmens, Michaela Morris, Les
Rudd, Stuart Bennett, All Wales
Senior Nurses Advisory Group
(AWSNAG) and the Service User
and Carer Research Partnership
(SUCRP) for valuable input into the
design of this research. Nicola
Gray and Robert Snowden are
co-authors of the WARRN
protocol for risk management and
safety planning. The authors also
thank Andrew Hider, Richard
Benson and Paul Rogers for input
into the original conception
of WARRN.
Robert J. Snowden is based at
the Department of Psychology,
Cardiff University, Cardiff, UK.
Jordan Holt, Nicola Simkiss
and Aimee Smith are all based
at Swansea University,
Swansea, UK.
Daniel Webb is based at
Aneurin Bevan Health Board,
Newport, UK.
Nicola S. Gray is based at
Swansea University, Swansea,
UK and Caswell Clinic,
Swansea Bay University
Health, Bridgend, UK.
DOI 10.1108/JMHTEP-03-2019-0016 VOL. 14 NO. 6 2019, pp. 399-410, © Emerald Publishing Limited, ISSN 1755-6228
j
THE JOURNAL OF MENTALHEALTH TRAINING, EDUCATION AND PRACTICE
j
PAGE399
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