Risk Assessment (person-centred)

If there are concerns that the person may lack capacity to make decisions around risk, then a proportionate mental capacity assessment must be carried out to determine whether this is the case.

If they lack capacity, decisions about the best way to manage risks must be made by applying the best interests principle of the Mental Capacity Act 2005.

Even when the person lacks capacity to make decisions around risk, they must be appropriately represented during the risk assessment and their views, wishes and feelings in relation to the risk must still be gathered and considered.

For further guidance see: Mental Capacity

If a person requests that somebody else is involved in the risk assessment, then you should involve that individual unless you have evidence that doing so would place the person (or another vulnerable adult or child) at increased risk of harm or abuse.

It may be relevant to consult with, or involve others in one or more of the stages of risk assessment (see above).

You can involve anyone in any way at any stage, so long as:

1. It is relevant for them to be involved;
2. Doing so will not increase the likely risk of harm or abuse;
3. The person has consented (or, if the person lacks capacity to consent, a best interests decision is made to this effect).

Examples of people it may be relevant to involve:

• Family members, friends or neighbours;
• A social worker;
• A health professional;
• The police.

If the person has current support from an advocate, you should ask them if they would like the advocate to be involved. If the person lacks capacity to make decisions around risk or consent to their advocate being involved, it would normally be in their best interests to involve their advocate. This will ensure they are represented in the risk assessment process.

If other people are involved in the risk assessment process, normal rules of confidentiality and information sharing apply.

See: Confidentiality and Information Sharing

Every situation will be different, but the table below shows some examples of risk that could be present:

Based on the evidence available, the following questions should be answered in order to identify the impact of likely risks identified:

1. How likely is it that the risk will occur?

1. A high likelihood?
2. A moderate likelihood?
3. A low likelihood?

2. What will the likely impact of taking the risk be for the person? (Positive and negative impacts)

1. A significant impact?
2. A moderate impact?
3. A minimal impact?

The positive or negative impact of a risk can be related to:

1. Physical or mental health;
2. Feelings and perceived happiness;
3. Finances;
4. Personal Relationships;
5. Safety;
6. Dignity;
7. Human Rights.

3. Is there likely to be a negative impact for others if the person takes the risk?

For example:

• Others being supported by the service;
• A family member or carer;
• Staff;
• The public.

Unless the nature of the risk is a risk of abuse or neglect, the purpose of stage 3 is to explore options that can reduce the negative impact of taking the risk. It is not about identifying measures that will eliminate risk altogether, especially when one or more positive impact on wellbeing has been identified.

Note: If the negative impact of the risk is abuse or neglect, this is different, and the aim would be to eliminate the risk.

In all cases, always begin with any measures that the person identifies or that they can take themselves (or with the support of an informal carer, family or friends). This will promote independence and maximise their control over their own life.

When exploring ways that the service can manage risks, measures should not:

1. Deprive liberty;
2. Impose restrictions on any other Human Right.

Deprivations of liberty and breaches of Human Rights must be authorised through a legal process.

For guidance, see: Equality, Diversity and Human Rights

If the person has capacity

If the person has the capacity to make decisions around managing risks, any plans put in place to support them with this should reflect their wishes. The only time that this would not be the case is:

• The measures put them at risk of abuse or neglect;
• The measures put others at risk of abuse or neglect;
• The measures mean the service would be providing unsafe care and treatment.

In this case, measures put in place must be as close to the person’s wishes as possible, only in place for as long as they need to be and only as restrictive as they need to be to manage the negative impact of the risk.

If the person lacks capacity

If the person does not have capacity to make decisions around managing risks, measures must be agreed by applying the best interests process in the Mental Capacity Act 2005. 

For guidance see: The Mental Capacity Act 2004 Resource and Practice Toolkit 

What is the overall level of risk that remains?

The overall level of risk that remains should be assessed as part of stage 3.

It should take into account:

1. The significance of any negative impacts;
2. How effective the agreed measures to reduce negative impacts are likely to be;
3. The likelihood that negative impacts will occur.

The overall level of risk will be either:

1. Significant;
2. Moderate;
3. Low;
4. No risk.

Remember, risk is a normal everyday experience, from which we all learn and grow.

Wherever possible you should take a positive approach to risk assessment.

This involves taking steps to actively encourage and support a person to take a risk when taking the risk is likely to achieve personal change, growth and promote individual wellbeing.

See: A Positive Approach to Risk