‘Having those conversations’: The politics of risk in peer support practice

Scott, Anne; Doughty, Carolyn; Kahi, Hamuera

doi:10.5172/hesr.2011.20.2.187

Cited by 31 publications

(33 citation statements)

References 16 publications

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“…The insufficiencies of the language of risk have been noted in research undertaken with peer support workers (Scott, Doughty, & Kahi, 2011). The importance of feeling safe and secure for older people was highlighted in Swedish research (Fagerstrom, Gustafson, Jakobsson, Johansson, & Vartiainen, 2011).…”

Section: Discussionmentioning

confidence: 97%

The Language of Risk: Common Understanding or Diverse Perspectives?

Clancy

Happell

Moxham

2014

Issues in Mental Health Nursing

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Risk as a concept now takes high priority in contemporary mental health services, with increasing pressure on mental health services to develop risk assessment and management practices. This focus on risk has been criticised for its over-reliance on measurement and management at the expense of therapeutic care and is perpetuated by the language of risk which reinforces power differentials and limits capacity for consumers and carers to influence discussions and debates. Furthermore, to date, most work in this area reflects adult settings with limited consideration of the unique needs of older people and the impact of risk assessment on the care they receive. A qualitative, exploratory approach was undertaken using individual interviews and focus groups to enhance understanding of how risk is conceptualised within an older persons' setting. Managers, clinicians, consumers, and carers from a large metropolitan service participated (n = 57). The language of risk was a major theme emerging from this work. This language, so familiar to providers of services, was not familiar to consumers and carers. A reframing of risk is necessary to reflect consumers' and carers' experiences and understandings. This approach will be essential in promoting consumer and carer participation within recovery-based services, reflecting significant goals of government policy.

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Section: Discussionmentioning

confidence: 97%

The Language of Risk: Common Understanding or Diverse Perspectives?

Clancy

Happell

Moxham

2014

Issues in Mental Health Nursing

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“…This is also in recognition that at times, clinicians might be limited to embrace all patient concerns about risks. However, peer advocacy, if independent from healthcare organizations, could be a step towards improving patient representation in risk management (Ridley, Newbigging, & Street, ), while peers having had similar experiences might better understand how managing risks may impact on patient lives (Scott, Doughty, & Kahi, ).…”

Section: Discussionmentioning

confidence: 99%

Patient perspectives of helpful risk management practices within mental health services. A mixed studies systematic review of primary research

Deering

Pawson

Summers

et al. 2019

Psychiatric Ment Health Nurs

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Accessible Summary What is known about the subject? Risk in psychiatry involves harm to self or others owing to mental health difficulties, for example iatrogenic effects of treatment, self‐harm, suicide and violence. Risk management is a framework to minimize risks, comprising of risk assessment, generation of risk management plans and evaluation of interventions. Literature has extensively explored risk management and presented a critique that its practices can lead to patient harm. However, there is a paucity of literature about what patients identify as helpful risk management practices, despite the potential for such patient views to ameliorate harm and improve mental health care. What this paper adds to existing knowledge Interpersonal relationships with clinicians, and communication that keeps patients involved and informed of management processes, were found to be central to beneficial risk management practices, while patients having agency and autonomy to influence their participation was also important. Beneficial interpersonal relationships and connectivity in the form of patients’ wider community of support were found to be influential in aiding risk management. Meaningful relationships, and particularly peer support, that maintained personal and collective identities were prevalent in the literature. What are the implications for practice? Rendering risk management more visible and accessible in practice might cultivate an openness that promotes patient participation. This includes drawing on a wider network of support, for example the patient’s friends and family, as well as having advocacy utilizing peer support. AbstractIntroductionMinimizing the harm that patients pose to themselves and others, due to mental health difficulties, is a central component of risk management in psychiatry. However, risk management itself can cause patient harm, but despite this and the potentially informative value of lived experience, little is known about what patients want or expect from risk management.AimTo review research and explore what patients consider beneficial in risk management practice.MethodA mixed studies systematic review utilizing PRISMA guidelines, alongside a convergent qualitative design to categorize findings.ResultsTwelve papers were identified, generating two categories of beneficial practices: interpersonal relationships and communication with clinicians; coupled with patient agency in their own risk management.DiscussionConnectivity appears important. Particularly patients feeling involved, and their voices being heard in both the identification of risks and then shaping risk management practice. Moreover, this included involvement of friends, family and peers to widen input and supportive networks beyond clinical relationships.Implications for PracticeRisk management needs to be an accessible part of care, which is more inclusive of patient views and needs. The latter might also be aided by drawing on the patient's wider community in order to provide more effective support and r...

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“…True service user engagement in the area of risk requires service users to be involved in the development of policy and guidelines, as well as in the design and evaluation of risk‐assessment tools. The collaborative involvement of service users at this level could assist practitioners and service users to work through the tension that exists within a philosophy that espouses mutuality, and a practice that has difficulty tolerating ambiguous or uncertainty (Scott et al ).…”

Section: Discussionmentioning

confidence: 99%

“…This was evident within this study, as much of the documentation reviewed did not address family involvement in any comprehensive manner. The absence of these recovery principles could be interpreted as reinforcing an organizational approach to risk that is practitioner focused, views a service user as a ‘risk object’ (Scott et al ), and is centred on risk control, perhaps reflecting the difficulties of reconciling the demands for professional and public accountability, with a recovery ethos that is underpinned by service user control, choice, autonomy, and opportunities for positive risk taking (Raven & Rix ; Robertson & Collinson ).…”

Section: Discussionmentioning

confidence: 99%

Documentary analysis of risk‐assessment and safety‐planning policies and tools in a mental health context

Higgins

Doyle

Morrissey

et al. 2016

Int J Mental Health Nurs

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Despite the articulated need for policies and processes to guide risk assessment and safety planning, limited guidance exists on the processes or procedures to be used to develop such policies, and there is no body of research that examines the quality or content of the risk-management policies developed. The aim of the present study was to analyse the policies of risk and safety management used to guide mental health nursing practice in Ireland. A documentary analysis was performed on 123 documents received from 22 of the 23 directors of nursing contacted. Findings from the analysis revealed a wide variation in how risk, risk assessment, and risk management were defined. Emphasis within the risk documentation submitted was on risk related to self and others, with minimal attention paid to other types of risks. In addition, there was limited evidence of recovery-focused approaches to positive risk taking that involved service users and their families within the risk-related documentation. Many of the risk-assessment tools had not been validated, and lacked consistency or guidance in relation to how they were to be used or applied. The tick-box approach and absence of space for commentary within documentation have the potential to impact severely on the quality of information collected and documented, and subsequent clinical decision-making. Managers, and those tasked with ensuring safety and quality, need to ensure that policies and processes are, where possible, informed by best evidence and are in line with national mental health policy on recovery.

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‘Having those conversations’: The politics of risk in peer support practice

Abstract: A B S T R A C T

Cited by 31 publications

References 16 publications

The Language of Risk: Common Understanding or Diverse Perspectives?

The Language of Risk: Common Understanding or Diverse Perspectives?

Patient perspectives of helpful risk management practices within mental health services. A mixed studies systematic review of primary research

Documentary analysis of risk‐assessment and safety‐planning policies and tools in a mental health context

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