Mental Health – Mitigation

So with Mental Health day approaching this Sunday I thought I would share some more of my thoughts and experiences.

Recently I have been discussing the importance of Risk assessment and the use of mitigation strategies for managing mental health episodes, and I thought I would try and share these with you.

As an introduction, I was introduced to the concept of risk assessments and risk management during my time working with many governmental and private organisations, also recent exposure in the press of these methods and their use in the current COVID pandemic, has made me review how I have implemented these concepts into the management of my Mental Health and how using these mechanics may be able to help others.

Lets start with the basics –

• What is Risk Management?
  • Risk management is the identification, evaluation, and prioritization of risks (defined in ISO 31000 as the effect of uncertainty on objectives) followed by coordinated and economical application of resources to minimize, monitor, and control the probability or impact of unfortunate events or to maximize the realization of opportunities. (Click for link to Wikipedia)
• What are Risk Assessments ?
  • Broadly speaking, a risk assessment is the combined effort of: identifying and analysing potential events that may negatively impact individuals, assets, and/or the environment; and making judgments “on the tolerability of the risk on the basis of a risk analysis” while considering influencing factors. (Click for link to Wikipedia)
• How are these techniques used by Business?
  • Some business’s use Risk Assessments as part of Risk Management to control various decision making processes. Some company’s use the practice to only control potential issues, others use it to influence all the decision’s they make.
• How is this relevant for Mental Health?
  • From my experience, a lot of the processes and methods used to manage mental health are medical variations of Risk Management. They concentrate on the potential Risk to the sufferers Mental Health stability posed through various actions and events.
  • As a sufferer you will have numerous Risk Assessments undertaken on you, about you, by medical professionals. These are to enable the medical professionals to make decisions and they ensure that they consider the relevant aspects and issues.
  • This blog is going to talk about how YOU can use these methods yourself to minimise the impact of your Mental Health on you and those around you.

So how can we are a Mental Health sufferer use these business based mechanics to help us manage our mental health.

For the most part, these methods consist of the following elements, performed, more or less, in the following order.

1. Identify the threats
2. Assess the vulnerability of critical assets to specific threats
3. Determine the risk (i.e. the expected likelihood and consequences of specific types of attacks on specific assets)
4. Identify ways to reduce those risks
5. Prioritize risk reduction measures

So wrt your mental health, lets follow this concept –

1. Identify the threats to your mental health – this is often a core part of mental health treatment, you are asked to identify your ‘triggers’ and aggravating situations. Possibly one of these is extended social interaction.
2. When looking at your mental health, this will nearly always be the vulnerable critical asset for the identified threat, now you may also identify other potential elements in your life that are at risk from the identified threat. So if extended social interactions are a threat to your mental health, then not attending them also poses a potential Threat to your family/friend relationships or to keeping your job when they are work related social interactions. But initially we need to focus on their impact on your mental health.
3. What are the risks to your mental health, now in our example the risk could be that following extended social interactions your mental strength to manage your mental health is reduced, so you are more vulnerable to further mental health issues or a full blown mental health episode.
   • In business you would try to quantify this risk in terms of Cash, wrt to your mental health you could do that, but it is potentially more relevant to provide a scale based on your subjective interpretation of its damage to your mental health.
   • In our example – it could be that one extended social interaction will make you less able to cope for a day, and a second within 24 hours of the first will reduce your ability to cope for a further 2 days. Thus the risk is further mental health episodes, and more time not being able to cope well.
4. Now we come to the core point of Risk Management – the management section – so having identified the risk we now need to identify what we can do to reduce the risk, please note the phrase here is not REMOVE the risk .. but it is REDUCE the risk.
   • Generally there are 4 options that any decision or action to reduce risk can be classified as .. these are
     • Avoidance (eliminate, withdraw from or not become involved)
       • This includes not performing an activity that could present risk.
         • In business this may be – Refusing to purchase a property or business to avoid legal liability is one such example.
         • In your own life – Avoiding airplane flights for fear of hijacking.
       • Avoidance may seem like the answer to all risks, but avoiding risks means giving in to your mental health and letting it dictate what you will and will not do.
         • That is not living with mental health, that is handing control to it, and is often the point at which others start to notice you are not coping with your mental health.
         • There will be certain risks to your mental health that avoidance is not a valid mechanic, Maybe attending Mental Health appointments risks your mental health by making you more unstable/distracted.
     • Reduction (optimize – mitigate)
       • Risk reduction or “optimization” involves reducing the severity of the loss or the likelihood of the loss from occurring.
         • For example in business, sprinklers are designed to put out a fire to reduce the risk of loss by fire. This method may cause a greater loss by water damage and therefore may not be suitable. Halon fire suppression systems may mitigate that risk, but the cost may be prohibitive as a strategy.
         • In your own life – it may be investing in a hands free unit for the car, so that when you are driving if you start to struggle you can call someone and talk to them.
       • Acknowledging that risks can be positive or negative, optimizing risks means finding a balance between negative risk and the benefit of the operation or activity; and between risk reduction and effort applied.
         • In business – By effectively applying Health, Safety and Environment (HSE) management standards, organizations can achieve tolerable levels of residual risk.
         • In your own life – by arranging for someone to collect you following a mental health appointment, you enable yourself to attend the appointment which is positive to your overall mental health, whilst not raising the risk to you and others of driving whilst struggling with mental health.
       • Another example of mitigating risk is to outsource the risk
         • In business – For example, a company may outsource only its software development, the manufacturing of hard goods, or customer support needs to another company, while handling the business management itself. This way, the company can concentrate more on business development without having to worry as much about the manufacturing process, managing the development team, or finding a physical location for a centre.
         • In your own life – if you identify driving as a potential risk, at times you may outsource the driving by taking a taxi or catching a bus, thereby mitigating the risk associated with you driving following a mental health appointment, whilst allowing you to benefit from attending the appointment.
     • Sharing (transfer – outsource or insure)
       • Briefly defined as “sharing with another party the burden of loss or the benefit of gain, from a risk, and the measures to reduce a risk.”
       • The term of ‘risk transfer’ is often used in place of risk sharing in the mistaken belief that you can transfer a risk to a third party through insurance or outsourcing.
       • This is different from Mitigating the risk as the aim is to totally transfer/share the risk with another
         • In business – this may be getting an insurance policy to cover the financial risk to the business
         • In your own life – This may be more about sharing than insuring, So wrt mental health this may be contacting your mental health professional or reaching out to your support network, in advance of a potential risk in order to get support and help prior to the risk occurring.
     • Retention (accept and budget)
       • Risk retention involves accepting the loss, or benefit of gain, from a risk when the incident occurs. All risks that are not avoided or transferred are retained by default.
         • In business – True self-insurance falls in this category. Risk retention is a viable strategy for small risks where the cost of insuring against the risk would be greater over time than the total losses sustained.
           • This includes risks that are so large or catastrophic that either they cannot be insured against or the premiums would be infeasible.
           • War is an example since most property and risks are not insured against war, so the loss attributed to war is retained by the insured.
           • Also any amounts of potential loss (risk) over the amount insured is retained risk.
           • This may also be acceptable if the chance of a very large loss is small or if the cost to insure for greater coverage amounts is so great that it would hinder the goals of the organization too much.
           • Businesses have critical incident plans to manage these occurrences. These plans are triggered when the event occurs so that the business knows what it is going to do to control the impact and mitigate further risks arising from it.
         • In your own life – There will always be risks you cannot foresee or cannot be avoided, mitigated or shared.
           • You can do as business does, and plan for these, by putting together a critical incident plan of your own.
           • This plan should be constructed with the help of your Mental Health Professional and support team/family.
           • It provides them with guidance on what to do if you suffer a critical mental health collapse and ensures that you get the right help and assistance at this time.
           • This needs to be put together whilst you are at a good place wrt your mental health, and will involve potentially difficult conversations with your family. But having it done and ready, will provide reassurance and a greater level of confidence over living with Mental Health.
5. The most important and final step – Prioritize risk reduction measures
   • This is the step that many businesses fail to follow, as it is the actual stage at which you have to do something, not just talk about it.
   • This is the step that is also the most important when reviewing your Mental Health management using risk management.
   • Having identified your risks, reviewed them and identified potential methods to manage them, you need to implement the identified methods to reduce the risks.
   • More importantly you need to share your planned methods with those whose support your will need.
   • You need to ensure that before making a decision you review your risk management plan and implement your planned methods. These need to take priority in your decision making process if you wish them to help you mitigate the impact of your Mental Health on you and your family.

Now that’s an awful lot of words, to basically say a classic business mantra –

“Failing to plan, is Planning to fail”

If you don’t plan on how to manage/mitigate the impact of your mental health on your life and actions, you will not manage your mental health and it will spiral out of control and potentially you will suffer an extreme episode.

For each sufferer that means something different, in the same way each of these plans needs to be personal, yes we will all share similar triggers and mitigation plan elements, but the overall plan will not be the same.

In business this is also true, and this process fails to achieve its expected benefits when a company provides lip service or uses a cookie cutter approach to risk management, the same will be true for your personal risk management.