This research is about the involvement in risk assessment and management of mental health service users considered by professionals to pose a potential risk to other people. The research was carried out due to concerns that the voices of these service users are not being heard in research, policy or practice. Many service users were aware that they could pose a risk to other people when experiencing psychosis and they wanted help to reduce the chances of this happening. Full and frank discussion of risk to others was difficult for many professionals. Some people could not be asked to participate in the study because they did not know they were considered to be a risk to other people. Reasons for talking about risk to others included the user's right to know what is written about them, and increased trust between user and professional, with the potential for collaborative risk management. Reasons against talking about risk to others included increasing stigma and distress; this prompted disengagement from services, and fears for personal safety. Levels of agreement between service users and professionals about risk and how to respond to it ranged from full agreement to very little or none. Service user involvement in risk assessment and management was variable and depended upon individual professional initiative. Few professionals were undertaking systematic risk assessment or risk management plans. Some service users influenced the support they received but, generally, users' main role was to accept or reject what was offered. Professionals had less room to accommodate user views where the risks were considered too high. Little use was made of advocates, and users were not provided with a full picture of the different supports available. Medication and supported housing emerged as key issues for potential tension and disagreement between service users and professionals. Serious gaps and inaccuracies were sometimes found in information held about service users that potentially put themselves and others at risk.
This research is about the involvement in risk assessment and management of mental health service users considered by professionals to pose a potential risk to other people. The research was carried out due to concerns that the voices of these service users are not being heard in research, policy or practice. Many service users were aware that they could pose a risk to other people when experiencing psychosis and they wanted help to reduce the chances of this happening. Full and frank discussion of risk to others was difficult for many professionals. Some people could not be asked to participate in the study because they did not know they were considered to be a risk to other people. Reasons for talking about risk to others included the user's right to know what is written about them, and increased trust between user and professional, with the potential for collaborative risk management. Reasons against talking about risk to others included increasing stigma and distress; this prompted disengagement from services, and fears for personal safety. Levels of agreement between service users and professionals about risk and how to respond to it ranged from full agreement to very little or none. Service user involvement in risk assessment and management was variable and depended upon individual professional initiative. Few professionals were undertaking systematic risk assessment or risk management plans. Some service users influenced the support they received but, generally, users' main role was to accept or reject what was offered. Professionals had less room to accommodate user views where the risks were considered too high. Little use was made of advocates, and users were not provided with a full picture of the different supports available. Medication and supported housing emerged as key issues for potential tension and disagreement between service users and professionals. Serious gaps and inaccuracies were sometimes found in information held about service users that potentially put themselves and others at risk.
Subject terms:
medication, mental health problems, mental health services, management, risk, risk assessment, risk management, severe mental health problems, stereotyped attitudes, stress, supported housing, user participation, user views, assessment;