Risk in mental health: a review on and of the psychiatrist

Abstract

Purpose The purpose of this paper is to review the perceptions of risk from the viewpoint of the psychiatrist, in the context of the expectations of patients, staff and society. Design/methodology/approach The paper is a reflection on clinical practice and narrative review of the literature. Findings There are significant problems in the prediction of risk, to do with the difficulty in attempting to predict any low prevalence outcome. Additional complications relate to societal expectations and the legal frameworks within which mental health is practiced. The evidence related to poor outcomes, such as suicide is very complex, occasionally appears contradictory, and caution is required in application. The paradigm of recovery provides a way forward in the assessment and management of risk that moves away from any pretence of future prediction and aims to engage with service users and their families in a supportive and complimentary way. Practical implications Use of a recovery framework, with a focus on need, as opposed to risk, would appear to benefit patients, carers and those delivering service. Originality/value This viewpoint enables a broader gestalt of the literature in the context of day-to-day clinical practice. This prevents the limitation of only examining the (largely) epidemiological literature, or just commenting on one clinician’s practice. It provides for a conceptualization of a way to move forward in the consideration of risk.