Positive risk taking: Whose risk is it? An exploration in community outreach teams in adult mental health and learning disability services

Abstract

An exploration was undertaken into outreach workers' experiences of positive risk-taking (PRT), including dimensions of risk staff face, and factors influencing their risk approaches. Two groups of staff working in local community outreach teams in adult mental health and learning disability services in a midlands city in England were interviewed about their work supporting service-users. Interview transcripts were explored using a qualitative methodology, Interpretative Phenomenological Analysis. Themes were generated through connections between the different participants' accounts. Participant reports highlighted the centrality of their relationships with the service-user and sometimes with support staff. Staff negotiate a balance of control over risk taking with the service user, mindful that misjudging this balance could ultimately result in service responses shaped by rare, adverse incidents rather than by the everyday risks faced by most service users. The study highlighted different understandings of PRT at different levels within organisations and a need for better informed, coherent organisational approaches to its practice. Interpersonal trust relies upon such organisational coherence; without it some staff may see themselves as gambling when undertaking PRT, whereas others may retreat into conservative interventions. Such conservative practices were perceived as potentially dangerous, promoting coercion and disrupting therapeutic relationships, and so increasing risks over a longer time period. Research is needed into the use of systems failure analysis and risk assessment tools to highlight how PRT can generate successful outcomes.

Keywords:

• positive risk taking
• community outreach
• Interpretative Phenomenological Analysis
• organisational coherence
• conservative practices

Acknowledgements

The authors would like to thank all the participants for their contributions to this study, and Professor Kevin Howells, Assistant Professor Jennifer Clegg, Dr Phil Houghton and the two anonymous referees for their valuable advice and comments.