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WARRN – a formulation-based risk assessment process: its implementation and impact across a whole country

Robert J. Snowden (Department of Psychology, Cardiff University, Cardiff, UK)
Jordan Holt (Swansea University, Swansea, UK)
Nicola Simkiss (Swansea University, Swansea, UK)
Aimee Smith (Swansea University, Swansea, UK)
Daniel Webb (Aneurin Bevan Health Board, Newport, UK)
Nicola S. Gray (Swansea University, Swansea, UK) (Caswell Clinic, Swansea Bay University Health, Bridgend, UK)

The Journal of Mental Health Training, Education and Practice

ISSN: 1755-6228

Article publication date: 9 October 2019

Issue publication date: 16 October 2019




Wales Applied Risk Research Network (WARRN) is a formulation-based technique for the assessment and management of serious risk (e.g. violence to others, suicide, etc.) for users of mental health services. It has been gradually adopted as the risk evaluation and safety-planning technique for all seven health boards in Wales. The purpose of this paper is to examine the opinions of WARRN as used within these health boards.


An online survey was disseminated to NHS clinicians in secondary mental health services to evaluate their perceptions of the use and effectiveness of WARRN. Data from 486 clinicians were analysed with both quantitative and qualitative methods.


Results indicated that the overall impact of WARRN on secondary mental health care was very positive, with clinicians reporting increased skills in the domains of clinical risk formulation, safety-planning and communication, as well as increased confidence in their skills and abilities in these areas. Clinicians also reported that the “common-language” created by having all NHS health boards in Wales using the same risk assessment process facilitated the communication of safety-planning. Crucially, NHS staff believed that the safety of service users and of the general public had increased due to the adoption of WARRN in their health board and many believed that lives had been saved as a result.


WARRN is perceived to have improved clinical skills in risk assessment and safety-planning across Wales and saved lives.



Thanks to Phill Chick, Dave Semmens, Michaela Morris, Les Rudd, Stuart Bennett, All Wales Senior Nurses Advisory Group (AWSNAG) and the Service User and Carer Research Partnership (SUCRP) for valuable input into the design of this research. Nicola Gray and Robert Snowden are co-authors of the WARRN protocol for risk management and safety planning. The authors also thank Andrew Hider, Richard Benson and Paul Rogers for input into the original conception of WARRN.


Snowden, R.J., Holt, J., Simkiss, N., Smith, A., Webb, D. and Gray, N.S. (2019), "WARRN – a formulation-based risk assessment process: its implementation and impact across a whole country", The Journal of Mental Health Training, Education and Practice, Vol. 14 No. 6, pp. 399-410.



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