Rethinking risk

Rethinking risk - Sarah Carr, SCIE

For people who use or work in mental health services the term 'risk of harm to self or to others' is an all too familiar phrase, derived from legal and professional terminology. So it's not surprising that people with mental health problems are often the subject of discussions about risk, danger and safety, most recently among practitioners and others involved with introducing self directed support and personal budgets in social care and health.

What is surprising is that practitioners who seem very concerned with risk and safety don't always ask the individual for their perspectives and understandings of risk. But what's crucial is being able to take positive risks with the right support and staying safe. This is key to independent living and staying in control, which are the goals of personalisation and approaches like personal budgets and direct payments. It's also very important for people with mental health problems who want to prevent crises and manage their mental health.

However, because of concerns about risk and safety, people with mental health problems sometimes aren't being offered personal budgets, particularly the direct payment option, as often as others might be. This is despite the fact that all sorts of research on personal budgets from the IBSEN study (opens new window) to SCIE Report 40 (opens new window) and the recent reports from the personal health budget pilot evaluation (opens new window) show that they can benefit greatly from the choice and control a personal budget can bring.

When SCIE looked at international research (opens new window) on how risk is defined, managed and enabled in self directed support schemes, we found two startling findings. The first was the lack of user perspectives in the research. The second was fact that practitioners can tend to avoid talking about risk enablement and safety with individuals and can sometimes make decisions about risk management without them. However, we concluded that the evidence shows it's vital to have those conversations as part of self direct support planning and review.

Understanding the individual's perspectives on risks and staying safe is a crucial part of person-centred support as a general practice principle - this applies to adult safeguarding too, as service users have said in a recent piece of SCIE work on user involvement in adult safeguarding (opens new window).

Recently the Joseph Rowntree Foundation made an important contribution to the knowledge on user's perspectives on risk when they published The right to take risks: Service users views of risk in adult social care (opens new window). The report, by Alison Faulkner, explores how perceptions of risk and rights can be different for mental health service users and makes two important points (among others!). The first is that mental health service users are more likely to be perceived as a source of risk rather than being at risk and being vulnerable in certain situations. The second is that service users had a particular perspective on risk that wasn't always understood by professionals - fear. This included fear for personal safety at times of distress and fear of losing independence or being disempowered.

So when thinking about how to address Think Local Act Personal's Making it Real (opens new window) markers of progress on risk enablement it's crucial to remember that people who may be perceived to be risky might be in vulnerable situations which make them afraid and put them at risk. Supporting people to identify what they're afraid of is part of enabling people to take positive risks in their lives while staying safe and in control.