Tensions of difference : reconciling organisational imperatives for risk management with consumer-focused care from the perspectives of clinicians and managers

Aims and objectives. To understand the impact of risk management and assessment on the delivery of mental health care from the perspectives of managers and clinicians. Background. The concept of risk is now embedded in contemporary mental health services. A focus on risk has been identified as a barrier to the provision of consumer-focused care; however, there is a paucity of research in this area, particularly being drawn from key stakeholders in the field. Design. Qualitative exploratory methods. Methods. In-depth interviews were conducted with managers and clinicians from a large metropolitan aged-care mental health service in Australia. The participants represented a range of disciplines and expertise across practice settings (community, inpatient and residential). Results. The theme tensions of difference emerged from this research. This theme referred to the tensions between accountability and attending to risk issues and consumer-centred care, with concerns being raised that procedural and bureaucratic accountability influence (often negatively) the provision of care. Differences in the perspectives of clinicians and managers were also evident in the perceived contribution of evidence-based practice in relation to risk. Conclusions. Prioritising risk management may be interfering with the capacity of clinicians and managers to provide quality and consumer-focused mental health care. Relevance to clinical practice. A deeper examination and reconceptualisation of the role and importance of risk in mental health care are needed to ensure the focus of service delivery remains consumer-focused.