Weekend lone working - risk management?

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Mephistofela
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Joined: Thu May 16, 2019 10:48 am

Weekend lone working - risk management?

Post by Mephistofela » Fri Jun 14, 2019 9:41 pm

Hello everyone! I will soon take on a half-day of working on Saturdays from home and this has brought up for me some risk-management related concerns that I am hoping I could discuss with you.

My job will consist of calling people currently on a CMHT waiting list in order to do a welfare check, discuss changes in circumstance, signpost to services, as well as do a risk and risk management review. For me this would be the first time when I will be having conversations with clients who are potentially experiencing suicidal ideation with plans and intent to harm themselves without the reassurance of having other mental health professionals in the same room with me. It makes me feel unsure and vulnerable to know that I could potentially be holding quite a significant amount of risk over the weekend and I have started ruminating about scenarios where clients harm themselves and I am held responsible. I have had training in risk assessment and management so I feel I am aware about the types of questions that I should ask as well as what to look out for, but I still cannot help feeling intimidated by the task of doing this without potential immediate support.

I have brought this potential issue up with the service and I feel that they are not particularly concerned about the risks and have advised me to contact the local psychiatric liaison or crisis team if I have concerns about clients.

I am just wondering if others have had the experience of having telephone contact with clients while lone working and how they managed the stress around doing this, as well as ensured that they kept clients safe, as much as possible.

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Pink
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Re: Weekend lone working - risk management?

Post by Pink » Sun Jun 16, 2019 5:22 am

Hi Mephistofela

I'm not sure of your banding, are you a qualified member of staff? I think if you're band 6 or above and qualified you will have the clinical skills to assess the risk and safety plan with clients appropriately, but there should still be a duty manager accessible as backup. However if you are not a qualified practitioner you absolutely should not be assessing risk over the phone, especially out of the blue (for the client) with CMHT clients and no backup. My cynical self is concerned that this is about the service trying to demonstrate that it has met its targets by putting in this saturday call to wait list clients who are not receiving any intervention. My experience of making these kind of calls is that it can evoke quite strong feelings from understandably frustrated clients, and it is difficult to hold the boundaries. I have to admit they often also feel unethical; it's really about meeting a service need rather than the client's and is pretty token. If you are not qualified, how can you assess whether somebody's mental health is deteriorating and they would benefit from a face-to-face review? It's not all or nothing with regard to suicide; there may be safeguarding issues or other complexity. If you are qualified, you will have the skills to do this and I don't think you would have posted this, as you would know the local pathways and how to manage it. I think you've done the right thing by raising your concerns with the service, but I don't think you should do the work if you are not qualified. I think you've been put in a very difficult position and risk leaving yourself vulnerable. Service managers often don't want to hear this kind of feedback; are there any clinical psychologists or senior staff you feel safe with in the service that you could discuss this with? I've certainly held a line on not allowing our PWPs or APs to do these kind of calls in the past.

Good luck with it, and I hope you find a way forward that works for you.

Pink
Kintsukuroi: 'to repair with gold'. the art of repairing pottery with gold or silver lacquer and understanding that the piece is more beautiful for having been broken.

@Sushipink22

Mephistofela
Posts: 3
Joined: Thu May 16, 2019 10:48 am

Re: Weekend lone working - risk management?

Post by Mephistofela » Sun Jun 16, 2019 2:36 pm

Hi Pink,

Thank you so much for your input. I have been feeling increasingly anxious about the prospect of doing this, and I spoke with a colleague about this at work who raised similar concerns. I have thought about this and while initially I saw it as a meaningful thing to do - contacting people who might have no other source of support at the moment - I now feel like this type of one-off call has the potential to cause more distress than to help people. I have received the low-intensity CBT training that allows you to work as a PWP, and you are right, it is probably not sufficient to allow me to confidently assess and manage the levels of risk that clients on a CMHT waitlist might present with, especially with no one around to ask for support. I think it would be better if I step back from this.

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