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In the UK, there are around 1.5 million carers of people with mental health problems providing substantial amounts of free care. Despite having a legal right to a ‘carer's assessment’, only a minority of mental health carers have had such an assessment. To try and understand why the uptake is so low, we undertook a small (n = 8) qualitative study exploring what mental health staff acting as ‘care co‐ordinators’ thought the barriers to, and facilitators of, carers' assessments might be, and how subsequent practice might be improved.We found that there was some confusion over the definition of ‘carer’ and over who should take responsibility for carer assessments. The main barriers to carers' assessments were the documentation used, the attitudes of staff (especially managers) and the fact that the needs of mental health carers often differed from those caring for people with a physical disability. Practice could be improved through: clarifying the definition of ‘carer’; education and training; redesigning the documentation; dovetailing service user and carer needs assessments; and through offering a wider choice of evidence‐based services as assessment outcomes. Improvements are unlikely to be successful, however, without the active support, expertise and engagement of carers.

The purpose of this paper is to examine empirical, epistemological and conceptual challenges and clinical narratives in the application of risk assessment and management in mental health.

The authors used a narrative review of empirical, conceptual and clinical literature.

The worldwide prevalence of violence in mental health settings remains high. Risk assessment and management approaches, while well intentioned as an attempt to reduce harm and increase people’s safety, have negligible effect on both. They are invariably individual centric, ignore wider environmental, societal and behavioural influences that foment violence and have a stigmatising effect on people using mental health services. They also reinforce the myth that people who are mentally unwell threaten society and that through current risk assessment and management approaches, we can minimise this threat.

There is a need to reconsider the study and application of violence risk assessment in mental health.

The practice of risk assessment and management in mental health is marred by an overuse of risk assessment measures that are limited in their predictive efficacy. As a result, they have little value in preventing, reducing and/or managing harm. The language of risk punishes and stigmatises service users and reinforces the image of menace. An alternative language of safety may nourish and protect. A collaborative approach to safety assessment based upon recovery-focussed principles and practices may fuse professionals and service users’ horizons. Combining service users’ self-perception, professionals’ sound clinical judgement, assisted by electronically derived risk algorithms and followed by evidence-based risk management interventions, may lessen the threat to service users, reduce harm and transform the practice of violence risk assessment and management.

Risk appraisals discriminate against the small number of people who have a mental illness and are risky, an example of preventive detention that is ethically questionable. On the basis of the limitations of the predictive efficacy of actuarial measures, it is ethically dubious to subject people to interventions with limited benefits. Risk assessment processes tend to reinforce stigma by classifying individuals as risky, sanctioning society’s prejudices and fear through scientific authority.

The increasing focus on risk assessment and management to tackle violence in mental health is fraught with empirical, conceptual and practical concerns; the authors have suggested ways in which these concerns can be addressed without compromising people’s safety.

This paper describes the process of developing a mental health and well‐being impact assessment tool in Lewisham, as part of an attempt to increase understanding of mental health and well‐being in the context of regeneration programmes. It is presented as a work in progress and the authors would welcome feedback and debate on the complex issues raised when adapting health impact assessment methods to the assessment of mental well‐being.

The general public and professionals from a range of backgrounds have increasingly become interested in autism spectrum disorders. This interest is particularly relevant to learning disability practitioners. Both autism and learning disabilities are independently associated with increased risk of mental health problems. Thus, when a person has learning disabilities and an autism spectrum disorder, a comprehensive assessment for mental health problems is of paramount importance. This paper provides an overview of the assessment of mental health problems in adults and children with neurodevelopmental disorders. The general assessment principles are outlined followed by assessment issues related to specific conditions such as psychoses, mood disorders and attention deficit hyperactivity disorder. Finally conclusions on the clinical implications are drawn.

Mental health assessment in people with learning disability can be a challenging process for clinicians. The more severe the cognitive impairment and level of learning disability, the less likely it is that the clinician can reliably confirm the diagnosis of a psychiatric disorder. Coordinated, multi‐modal interdisciplinary team assessment is the way forward, as it draws together the bio‐psychosocial model of interviewing and mental health care planning. In this article we go through the psychiatric assessment structure and highlight the differences in assessing people with learning disability compared with their peers in the general population. We give special consideration to mental health assessments in emergency settings, and to people with challenging behaviour.

Many patients referred by their GP for an assessment by secondary mental health services are unlikely to ever meet eligibility thresholds for specialist treatment and support. A new service was developed to support people in primary care. “the authors evaluate” whether the phased introduction of the Lambeth Living Well Network (LWN) Hub to a population in south London led to: a reduction in the overall volume of patients referred from primary care for a secondary mental health care assessment; and an increase in the proportion of patients referred who met specialist service eligibility criteria, as indicated by the likelihood of being accepted in secondary care.

The evaluation applied a quasi-experimental interrupted time series design using electronic patient records data for a National Health Service (NHS) provider of secondary mental health services in south London.

Scale-up of the Hub to the whole of the population of Lambeth led to an average of 98 fewer secondary care assessments per month (95% CI −118 to −78) compared to an average of 203 assessments per month estimated in the absence of the Hub; and an absolute incremental increase in the probability of acceptance for specialist intervention of 0.20 (95% CI; 0.14 to 0.27) above an average probability of acceptance of 0.57 in the absence of the Hub.

Mental health outcomes for people using the service and system wide-service impacts were not evaluated preventing a more holistic evaluation of the effectiveness and cost-effectiveness of the LWN Hub.

Providing general practitioners with access to service infrastructure designed to help people whose needs cannot be managed within specialist mental health services can prevent unnecessary referrals into secondary care assessment teams.

Reducing unnecessary referrals through provision of a primary-care linked mental health service will reduce delay in access to professional support that can address specific mental-health related needs that could not be offered within the secondary care services and could prevent the escalation of problems.

The authors use NHS data to facilitate the novel application of a quasi-experimental methodology to deliver new evidence on whether an innovative primary care linked mental health service was effective in delivering on one of its key aims.

In the assessment of student nurses, there is limited research exploring why the contributions of people with lived experience (LE) have an impact on learning. The purpose of this paper is to compare the nature of feedback provided to students by people who have both worked in and used mental health services.

To explore the nature of qualitative student feedback generated from an assessment involving people who have experience of using and working in mental health services. Therefore, an inductive content analysis conducted on the formative written feedback provided to students following a simulated assessment.

The results demonstrate significant similarities in the feedback provided by those with LE of using and working within mental health services, suggesting a shared conceptualisation of professionalism.

The research indicates the potential socialisation of professionals and service users to not only the assessment process but also the professional expectations of mental health nurses. These findings resonate with Barker et al.’s (1999) description of the “pseudo ordinary me” and emphasise the principles and importance of person-centred care.

The paper highlights that assessment approaches which incorporate feedback from people with LE offer a vehicle to demonstrate and explore how attributes, subjectively associated with professionalism, can be recognised and developed by student mental health nurses.

This paper examines the process of assessing mental health needs for people with learning disabilities, considering questions of targeting, mental illness and challenging behaviour, diagnostic assessment and quality of life. It recommends comprehensive assessment within an integrated care approach.

The purpose of the paper is to report the findings of a small scale indicative research project. The project explores the assessment of detained persons in police custody by Forensic Physicians (FP).

A range of information was collected in every case where custody staff had identified a mental health concern and requested an FP assessment. As well as information about demographic factors, this would include questions regarding any links that the individuals had with community‐based mental health services. As well as this information, anonymous custody records and force adverse incident records for the month were examined.

In the month of the project, 59 FP assessments were requested. Only six members of this group had any contact with community‐based mental health services: two with a social worker, two with a CPN and two with a psychiatrist. Of this group, three had not been in contact with mental health services for over a month.

The size of the cohort and variety of arrangements for providing nursing and social care support in custody settings may limit the generalisation of the findings.

This study highlights that there is a group of individuals whose mental health causes concern to the police in a custody environment. In this study, the overwhelming majority of the group have no contact with mental health services. The research supports the recommendations of the Bradley Review for wider health care provision in custody settings.

The paper highlights that fully effective community mental health services need to consider police custody settings as a key point for intervention.

This paper identifies the challenges of interpreting and implementing appropriate eligibility criteria and assessment processes in adult mental health services, with reference to an inner‐city Trust's own protocols. Central guidance, local interpretation and professional judgment are all legitimate contributions, but also confound both the concept and processes of entry to service.