This NIHR-funded forensic mental health research project is evaluating the current use of risk assessments and management planning in adult secure mental health services, and if a more consistent collaborative approach to these practices would improve patient experiences and outcomes.

Assessing risk is central to many decisions about treatment. It is important to consider how best to involve patients and their support networks in these assessments and decisions, especially because treatment might involve restricting someone’s freedom to maintain safety. However, currently the level of collaboration in the secure pathway, and the effectiveness of approaches, is not known.

CoRAS (COllaborative Risk ASsessment and management across the secure mental health pathway in England) is a research project funded by the NIHR Policy Research Programme and will explore this important evidence gap, because a) there is potential to improve outcomes if implemented more effectively and consistently, and b) it is likely to vary between different groups of people, which may worsen inequality and poor outcomes.

Dr Daniel Whiting, Honorary Consultant Forensic Psychiatrist at Nottinghamshire Healthcare NHS Foundation Trust and Clinical Associate Professor in Forensic Psychiatry at the University of Nottingham, and Professor Seena Fazel, Professor of Forensic Psychiatry at the University of Oxford and Honorary Consultant Forensic Psychiatrist at Oxford Health NHS Foundation Trust, will lead the project, with support from Notts Healthcare colleagues Dr Cat Jeynes (Senior Research Delivery Officer), and Naomi Clifford (Research Assistant). Co-investigators include specialist academics working at the Universities of Nottingham and Manchester, and an experienced patient and public involvement (PPI) leader and expert by experience from the charitable organisation, Rethink Mental Illness.

This study will involve a realist review of risk assessment and management planning across adult secure mental health services in England to understand what works, describe what is happening in practice and determine how a more collaborative approach could be effectively and consistently implemented to improve patient experience and the way decisions are made about care.

The realist review approach that will be used in this project is a type of evidence review that assesses the specific contexts in which a certain intervention may or may not work. This type of review acknowledges the complexity of the health care system and the lives of the people who interact with it — and the fact that change resulting from the implementation of complex interventions can be based on many different variables with potentially different outcomes in different situations.

The project will commence in September 2024 and be completed by March 2026.

This study is funded by the NIHR Policy Research Programme (NIHR 206609). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Publications

Equality Impact Assessments

EQI Form and Action Plan - CORAS PPIE Group

EQI Form and Action Plan - CORAS Realist Synthesis