Chapter Five
Information sharing and risk management
5.1 It is vital for the effective protection of the public that information on patients who are assessed as posing a risk of serious harm to others as a result of their mental disorder is able to be exchanged between those agencies involved in the patient's care and treatment (health and social services), and other relevant agencies, particularly criminal justice agencies.
5.2 The new legislation will include a new statutory duty covering the disclosure of information about patients suffering from mental disorder between health and social services agencies and other agencies (for example, housing and criminal justice agencies), where it can be justified. This will include cases where there is a significant risk of serious harm to others from the patient. Such information will of course be kept confidential by the receiving agencies (except in those limited and specified circumstances where its release is justified, for example, where specific individuals are thought to be at risk of harm from the person concerned and would need to be alerted for their own safety).
5.3 There will also be a duty on health and social services agencies to ensure that appropriate arrangements for storing and exchanging confidential patient information with other agencies are in place. Guidance in the Code of Practice on the new legislation will support the application of the new power and set out general principles that should be followed. (See Part One, paragraph 5.34.)
Good Practice
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Risk Assessment, Management and Audit System (RAMAS)
RAMAS is a multi-agency approach to risk assessment and management which was developed in 1994 to specifically address concerns raised by inquiries into homicides by individuals with mental disorder. It aims to:
ensure that people who pose a risk to themselves or others do not 'fall through the care net';
ensure that a comprehensive health, social and personal needs assessment is carried out for everyone who comes into contact with services;
ensure that a clear, accurate, complete risk and care assessment is carried out in order to collate the 'intelligence' through which robust risk and care management and audit may be made;
to provide a common language for inter-agency communication and collaboration on risk and care;
facilitate an integrated, co-ordinated, user friendly and positive approach to public safety and individual care;
facilitate case and workload management through a standardised method which provides evidence-based care, clear, shared goals and good practice.
Contact: Dr Margaret O'Rourke, Consultant Forensic Clinical Psychologist,
Tel: 01483 452754. Website: www.ramas.co.uk
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Local arrangements for risk assessment and management in the community of potentially dangerous offenders
5.4 Multi Agency Risk Panels, or Public Protection Panels have been established across the country primarily to satisfy the requirements of the Sex Offender Act 1997, which placed a duty on the police to monitor those offenders who are required to be on the sex offender register. Many panels have subsequently extended their remit to respond to the risks posed by other potentially dangerous offenders in their communities and a range of agencies are now involved in local arrangements, led by police and probation services.
5.5 The Criminal Justice and Court Services Act 2000 amends the Sex Offenders Act 1997 and places a statutory duty on police and probation services to establish arrangements for the assessment and management of risks posed by relevant sexual or violent offenders in the community, and to monitor those arrangements. It also broadens the scope of those subject to these local risk management arrangements to include offenders who have received a hospital order under the Mental Health Act 1983 following conviction for a sexual or violent offence. The provisions are expected to come into force on 1 April 2001.
5.6 Guidance will shortly be issued to responsible authorities on the discharge of their functions under these new statutory provisions. This will be based on a recent review by the Home Office of good practice in risk management arrangements across the country. The guidance will stress the importance of involvement by agencies such as health, social services and housing in support of the police and probation services.
5.7 Provisions for a new statutory duty covering the disclosure of patient information between health and social services agencies and other agencies where it is justified, for example, in the public interest, will support these new risk management arrangements led by the criminal justice system. It is only by effective inter-agency working that the right risk management packages for individuals will be put in place and risk managed in the most effective way.
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