Structuring and self-competence: How they can make a difference in assessing and managing risk

Background: Assessing risk is a mandatory part of standard mental health practice in the West, but is fraught with difficulties. Structuring and self-efficacy are important factors, but there is near absence of work on this aspect from India. This study aimed to determine how these two concepts can make a difference in assessing and managing risk. Methods: A prospective cross-sectional study over 2 months was conducted with 35 participants (dealing with patients with mental illnesses) from Department of Psychiatry, Government Medical College and Hospital-32, Chandigarh and 30 participants in comparison group (dealing with people with intellectual disabilities) from Regional Institute of Mentally Handicapped-31, Chandigarh using Risk Assessment and Management Self-efficacy Scale (RAMSES). Results : In overall sample (n = 65), only 17% reported using a screening instrument while 62% reported use of screening questions thereby making the total prevalence of use of screening instruments and/or questions as 79%. Total RAMSES score and mean score for all three domains was 7.14 and between 7 and 8 respectively for the study group; while for the comparison group, the total RAMSES score was 7.92 and the mean score for all three domains was between 7 and 9 respectively indicating above average level of reported self-efficacy. For the individual RAMSES items, a lower competency (<7 for study group) and (<8 for comparison group) was reported for formal or written process related to synthesis of risk assessment and risk management. The study group showed lower self-efficacy scores on majority of individual RAMSES items, 2/3 domains and overall score. Conclusions: Indian mental health professionals of different backgrounds with varying duration of experience reported reasonable degree of competence regarding risk assessment (primarily for the risk toward self and others). Hence, we recommend that they embrace the western concept of "risk assessment" by incorporating structuring as a concept and ensuring more robust and appropriate documentation