Abstract
Risk assessment and management is a major component of contemporary mental health practice. Risk assessment in health care exists within contemporary perspectives of management and risk aversive practices in health care. This has led to much discussion about the best approach to assessing possible risks posed by people with mental health problems. In addition, researchers and commentators have expressed concern that clinical practice is being dominated by managerial models of risk management at the expense of meeting the patient's health and social care needs. The purpose of the present study is to investigate the risk assessment practices of a multidisciplinary mental health service. Findings indicate that mental health professionals draw on both managerial and therapeutic approaches to risk management, integrating these approaches into their clinical practice. Rather than being dominated by managerial concerns regarding risk, the participants demonstrate professional autonomy and concern for the needs of their clients.
Highlights
Risk assessment and management is a major component of contemporary mental health practice
In this paper we report on the findings of a study exploring the risk assessment practices of a multidisciplinary mental health service in Australia
Concerns have been raised about the diminishment of professional discretion and autonomy, and the deskilling of professionals as a result of the introduction of regulatory regimes, such as risk management, into the health sector (Alaszewski, 2005; McDonald, Postle & Dawson, 2008); others have found that health professionals are able to interpret and negotiate risk management policies to maintain professional autonomy (Ruston, 2006; Sawyer, 2009)
Summary
Risk assessment and management is a major component of contemporary mental health practice. The focus on risk in the provision of mental health care arose as a consequence of a complex set of social, political, and economic changes This includes the adoption of marketbased principles in the provision of health care, more generally, and a consequent rise in managerialism with its focus on the use of managerial techniques to optimise organisational performance, in the 1970s and 1980s (Sawyer, Green, Moran, & Brett, 2009; Alaszewski, 2005; Gregory & Holloway, 2005). This was underpinned by the contemporary framework of a “risk aversive culture” Policy and service reform to implement the principles of recovery—which focus on the consumer’s goals, potential for change and growth, and a transparent and collaborative relationship with health care professionals (Barker & Buchanan-Barker, 2005)—has been identified as important in maintaining a recovery focus (Ramon, Healy, & Renouf, 2007; Rickwood, 2005; Substance Abuse and Mental Health Services Administration, 2005), and inherent in such principles is, the notion of risk:
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