Innocent until proved guilty?
| Date | 13 November 2017 |
| Pages | 249-251 |
| DOI | https://doi.org/10.1108/MHSI-09-2017-0035 |
| Published date | 13 November 2017 |
| Author | Rachel Perkins,Julie Repper |
| Subject Matter | Health & social care,Mental health,Social inclusion |
Rachel Perkins and Julie Repper
Innocent until proved guilty?
Common approaches to risk assessment can run counter to recovery initiatives and breach
human rights.
Policy and practice in mental health services prioritise both the promotion of recovery and the
minimisation of risk (Department of Health, 2011; NHS England, 2016). Often these two appear
mutually incompatible:
Recovery focuses on strengths and personal resources and is about rebuilding your life and exploring
your possibilities; self-control and self-determination; taking back control over your life, destiny and
the treatment/support you receive to deal with challenges you face. Traditional approaches to risk
assessment and management focus on problems, deficits and dysfunctions and are about
professionals taking control and managing risk; avoiding danger by stopping people doing things that
are considered risky (Perkins and Repper, 2016, p. 101).
Recovery necessarily involves taking risks, but safety is important. The challenge is to develop an
approach to risk that is focussed on promoting recovery: enabling people to do the things they
value as safely as possible. An approach to risk that moves away from “managing risk”
to “promoting safety and opportunity”. And an approach to risk that is founded on the shared
decision making and shared responsibility for risk. The need for such an approach is described
by the Department of Health (2007) in the publication “Best Practice in Managing Risk”which
says that risk management should be “conducted in a spirit of collaboration and based on a
relationship between the service user and their carers that is as trusting as possible”and must be
“built on a recognition of the service user’s strengths and should emphasise recovery”
(Department of Health, 2007, p. 5, authors’emphasis).
There are an increasing number of publications exploring what a recovery-oriented approach to
risk might look like (see e.g. Boardman and Roberts, 2014; Perkins and Repper, 2016).
However, what is lacking from these analyses is a consideration of the “risk history”element of
such endeavours.
It is taken as read that a risk assessment should include a “risk history”: a list of notable events in
which the person was deemed to be a risk to themselves or to other people. Everyone is
supposed to have an assessment of their risk history and it follows the person around from
service to service. It is not uncommon for it to catalogue a series of alleged wrong doings that
amount to “crimes”(e.g. violence, aggression and damaging property) that, outside a mental
health setting, might be called “breach of the peace”,“actual bodily harm”,“criminal damage”
and the like.
If anyone outside mental health services were accused of such crimes they would have a right to
a legal process and ultimately a trial where the accusers would have to prove the person’s guilt
“beyond reasonable doubt”. The person would be deemed innocent until proved guilty:
ei incumbit probatio qui dicit, non qui negat –the burden of proof is on the one who declares, not
the one who denies. This is a legal right and a human right under Article 11 of the United Nations
(1948) Universal Declaration of Human Rights:
Everyone charged with a penal offence has the right to be presumed innocent until proved guilty
according to law in a public trial at which he has had all the guarantees necessary for his defence
(United Nations, 1948, Universal Declaration of Human Rights, p. 3).
Yet it is a right denied many who are deemed to be “mentally ill”.
DOI 10.1108/MHSI-09-2017-0035 VOL. 21 NO. 5 2017, pp. 249-251, © Emerald Publishing Limited, ISSN 2042-8308
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MENTALHEALTH AND SOCIAL INCLUSION
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Editorial
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