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  4. Ordinary risks and accepted fictions: how contrasting and competing priorities work in risk assessment care planning




Ordinary risks and accepted fictions: how contrasting and competing priorities work in risk assessment care planning



Staff, Students, Academics

Speaker: Dr Michael Coffey, Associate Professor, Department of Public Health, Policy and Social Sciences, Swansea University

Series: This seminar is jointly presented by the Centre for Mental Health Research and the Joint Institute for Mental Health Nursing, as part of the School of Health Sciences seminar series


Clear communication and information sharing is considered crucial to recovery-focused mental health service delivery. Effective mental health care planning and co-ordination includes the key component of managing risk and safety.


Using data from our cross national mixed method study of care planning and co-ordination we examined what service users and workers say about risk assessment and management and the extent to which this was demonstrated in care plans.


Data included research interviews (n=117) with service users, family members and workers, across 4 English and 2 Welsh National Health Service sites. Care plans were also reviewed for service users (n=33) using a standard template.


Participants have contrasting priorities in relation to risk. Service users see some benefit in discussions about risk but cast the process as a worker priority that serves to confirm a deviant status and may lead to loss of liberty. Relationships with workers are key to family members and service users; however worker claims of commitment to involving people in the care planning process do not extend to risk assessment and management plans. Care plan reviews found limited involvement of service users and family in risk assessment and management procedures. Workers locate risk as coming from the service user, are risk averse and appear to prioritise the procedural aspects of assessment over direct involvement in risk management.


Despite its limitations risk assessment is treated by participants as legitimate work. It operates as an accepted fiction in which participants ignore or downplay the poor predictive ability of mental health risk assessment in the interests of achieving a form of normative certainty. As a consequence risk adverse options are offered and service users are steered away from opportunities for ordinary risks via communicative relationships that hinder the mobilisation of their strengths and abilities.

About the speaker

Michael Coffey is a mental health nurse academic who researches experiences of service delivery using a multiple perspectives approach. He has previously worked as a community mental health nurse in generic and forensic services in London. Michael has researched identity work of people leaving forensic services and social care mental health recovery services and is a member of the COCAPP research team. He is currently investigating patient reported outcomes related to transfer from secondary mental health services to primary care services in Wales.

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When & where

12.45pm - 2.00pmMonday 25th April 2016

MG26 Myddelton Street Building City, University of London 1 Myddelton Street London EC1R 1UW United Kingdom