8. Identifying and Evaluating Risks

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The training programme addresses not only the expected positive outcomes but also the possible risks of the mental health promotion intervention(s) being presented for both individuals and communities. All changes involve a degree of risk-taking. Empower individuals and communities to decide the level of risk they are prepared to take with their health and safety.

 

What this criterion means for care professionals

 

Care professionals must understand that every health act will have expected benefits but also possible risks to the individual or the community. For example, sexual health promotion in schools might create difficulties at home for students from different cultural backgrounds. Suicide prevention programmes might put the idea of suicide into the mind of some fragile schoolchild, or might for example show him, without intending to, a more effective suicide method. All interventions can bring about circumstances that go beyond people’s control. Each decision about the intervention should be approved by all stakeholders and each decision which affects people’s lives should be assessed in terms of the possible benefits and harm that it could bring to individuals, different stakeholder groups or the local community. If harmful effects can be foreseen, but at the same time in a context of important positive results, professionals should be able to create a plan which includes not only risks but also tactics and strategies for reducing or preventing harm and handling it should it happen. Participants must also understand the notion of positive risk-taking: for example, for many mental health service users, integrating community activities will often bring advantages but at the same time increase the risk of being stigmatised or discriminated against because of their mental illness. Disclosure (of a serious illness, being gay or lesbian, etc) inevitably involves both positive and negative outcomes. All changes involve a degree of risk-taking.

 

Illustrate how this criterion could be respected for initial training

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Introduce standard risk assessment techniques and simulation studies. Study mental health promotion projects where unexpected results have occurred. Risk assessment is to be seen as a tool for planning interventions that are in tune with risk and not based on exaggeration or fear. It is important that students learn to normalise risk - not to become too protective and paternalistic, but rather to creatively organise responses that allow people with mental health projects to take calculated risks.

 

Ideas for training modules/exercises

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• Present several mental health promotion programmes and ask participants to discuss and list both positive and negative risks of these programmes.

• Develop modules for risk assessment in mental health promotion.

• Analyse risks and how to take them into account when designing mental health promotion programmes. For example:

  • the risk of social stigmatization of obese people in a programme promoting healthy eating.

  • the risk of social exclusion of specific disability groups, for example of impotent men in a sex education programme

  • the risk of unwanted pregnancy in mental health promotion programmes on emotional and sexual health

  • Discuss the positive and negative risks of training students themselves about mental health promotion issues

• Conducta risk analysis of a mental health promotion action targeting the social skills of adolescents. Identify possible hazards and benefits of different situations that might arise during training. For instance, if participants are asked to share their feelings or if contradictory opinions appear.

 

Illustrate how this criterion could be respected for continuous training

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Continuing training should encourage participants to analyse everyday risk situations including more complex situations where teamwork might be necessary. Risk assessment should also include risks concerning resourcing and management problems. For example: mental health promotion actions targeting healthy eating in children entail risks in terms of possible eating disorders such as anorexia nervosa, bulimia nervosa or compulsive overeating, but, at the same time, resourcing or structural risks, for example the exclusion of certain groups who cannot access a healthy diet due to lack of resources (poor, children in a custody, etc.) or risks with adapting evidence-based programmes to local contexts with different resourcing structures.

 

Health promotion projects can also sometimes find themselves in delicate areas of conflict between stakeholders within the same community. This can happen, for example, when members of a certain profession enter sectors which are strongly influenced by the philosophy of some other profession, for example when care professionals enter schools, or closed institutions such as prisons, where policy or work habits might be in contradiction with the mental health promotion project at hand. This kind of situation can sometimes lead to negative effects for professionals, who then become reluctant to enter into such projects.

 

Ideas for training modules/exercises

• Collect examples of risks from participants’ professional and personal experiences with health promotion programmes.

• Ask participants to design mental health promotion programmes, taking into account possible risks and making a plan for their management. Then assess risks related to the unavailability of resources: for example, that the premises are occupied in the prescribed time period or that financial resources are suddenly reduced. Then include risks arising from the unpredictability of project work: for example, an expert falls ill, a consultant does not wish to participate. Build into the programme appropriate back-up plans and risk-reduction strategies.

• Provide tools for planning and project management, including identifying resourcing and management risks. Example: a mental health promotion action targeting healthy eating in children has risks in terms of possible eating disorders such as anorexia nervosa, bulimia nervosa and compulsive overeating, etc. but, at the same time, resourcing or structural risks, for example the exclusion of certain groups who cannot access a healthy diet due to lack of resources (poor, children in a custody, etc.) or risks with adapting evidence-based programmes to local contexts with different resourcing structures or multiple stakeholder groups who may not necessarily agree.

 

Consult the following Resource Kit for further information, relevant legal and policy texts, and examples of posters, slides and training programmes that respect this criterion:

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