Abstract
BackgroundCommunication and information sharing are considered crucial to recovery‐focused mental health services. Effective mental health care planning and coordination includes assessment and management of risk and safety.ObjectiveUsing data from our cross‐national mixed‐method study of care planning and coordination, we examined what patients, family members and workers say about risk assessment and management and explored the contents of care plans.DesignThematic analysis of qualitative research interviews (n = 117) with patients, family members and workers, across four English and two Welsh National Health Service sites. Care plans were reviewed (n = 33) using a structured template.FindingsParticipants have contrasting priorities in relation to risk. Patients see benefit in discussions about risk, but cast the process as a worker priority that may lead to loss of liberty. Relationships with workers are key to family members and patients; however, worker claims of involving people in the care planning process do not extend to risk assessment and management procedures for fear of causing upset. Workers locate risk as coming from the person rather than social or environmental factors, are risk averse and appear to prioritize the procedural aspects of assessment.ConclusionsDespite limitations, risk assessment is treated as legitimate work by professionals. Risk assessment practice operates as a type of fiction in which poor predictive ability and fear of consequences are accepted in the interests of normative certainty by all parties. As a consequence, risk adverse options are encouraged by workers and patients steered away from opportunities for ordinary risks thereby hindering the mobilization of their strengths and abilities.
Highlights
Contemporary mental health policy in England and Wales directs that care provision is recovery oriented.[1,2] The recovery vision requires services to provide the means to enable involvement of people in their care
Relationships with workers are key to family members and patients; worker claims of involving people in the care planning process do not extend to risk assessment and management procedures for fear of causing upset
Despite limitations, risk assessment is treated as legitimate work by professionals
Summary
Contemporary mental health policy in England and Wales directs that care provision is recovery oriented.[1,2] The recovery vision requires services to provide the means to enable involvement of people in their care. Risk assessment is an important element of care planning and a contemporary concern for workers and service users alike with significant consequences for restrictions on the liberty of patients.[15] Risk in mental health care is positioned variously across the literature as an on-going assessment process rather than an outcome,[16] usually a professional activity and perhaps an outcome arising in social contexts.[17] In the mental health field, risk is constructed as a potential negative outcome or behaviour arising from the unwanted actions of people using services.[18] The focus is centred on two main concerns: the risk the person presents to themselves in the form of suicide or vulnerability and the risk the person presents to others The first of these risks is most common with approximately 5500 suicides each year in the UK, 30% of which are known to mental health services.[19,20,21]
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