Assessing risk with older people in mental health care

Risk is commonly defined as a negative threat which needs to be controlled and mitigated, as a concept it takes high priority in contemporary mental health services. There is increasing pressure on mental health services to develop risk assessment practices. However, to date, most work and exploration reflects adult settings with limited consideration of the unique needs of older people, and the impact of risk assessment on the care they receive. The aim of this thesis is to present a multi perspective, in-depth understanding of assessing risk with older people in mental health care. A qualitative, exploratory approach was undertaken using individual interviews and focus groups. Managers, clinicians, consumers and carers from a large metropolitan, older persons' mental health service participated (n=57). Three main themes emerged: Relating and risk; Tensions of difference; and Balancing uncertainty. The findings suggest that providers and recipients of services had different understandings and experiences of risk. At the organisational level consumers were viewed objectively as being at risk and requiring risk mitigating interventions, whilst consumers and carers viewed risk subjectively in terms of feeling safe. The language of risk, so familiar to providers of services, was not familiar to consumers and carers. Clinicians had to navigate these disparate views and languages, often negotiating risk-taking interventions with consumers. Carers frequently felt ignored and excluded from decisions even though they were usually the main support person. These findings led to the development of a Framework for Safety, where the consumer is central within a balance of threats, protective factors and collaborative supports. Reframing of risk is necessary to reflect consumers' and carers' experiences and language, while supporting clinicians to create opportunities for risk-taking interventions. This approach will be essential in promoting consumer and carer participation within Recovery-based services, reflecting significant goals of government policy.