Rethinking risk: a narrative approach
| Pages | 54-62 |
| Published date | 08 January 2018 |
| DOI | https://doi.org/10.1108/JMHTEP-06-2017-0043 |
| Date | 08 January 2018 |
| Author | Anne Felton,Theo Stickley |
| Subject Matter | Health & social care,Mental health,Mental health education |
Rethinking risk: a narrative approach
Anne Felton and Theo Stickley
Abstract
Purpose –The assessment and management of risk is central to contemporary mental health practice.
The emergence of recovery has contributed to demands for more service user centred approaches to risk.
The purpose of this paper is to examine the potential of narrative as a framework for understanding risk and
safety in mental health care.
Design/methodology/approach –Narrative theory is adopted to structure a debate examining the
potential role of a narrative approach to risk assessment and inform future practice.
Findings –There is a danger that even within services, people with mental health problems are
understood in terms of their riskiness perpetuating an image of service users as “dangerous others”.
This is confounded by a disconnection with individual context in the risk assessment process. Narrative
centralizes the persons’subjective experience and provides a contemporaneous self-account of their
identity. This situates risk within a context and creates possibility for greater understanding of coping,
strengths and resilience.
Originality/value –There has been a call for new ways of working with risk in mental health which facilitate
safety and recovery. There is limited examination of what this might actually look like. This paper presents
narrative as an approach that may achieve these aims.
Keywords Narrative, Mental health, Risk, Recovery, Other
Paper type Viewpoint
Introduction
Risk assessment and management in mental health care is a contested area. Both risk
assessment tools and the judgement of professionals have been criticised for a lack of accuracy
and reliability, drawing into question the evidence for the approaches currently adopted (Morgan,
2008; Wand, 2011; Fazel et al., 2012). Yet risk remains a core component of mental health
practice (Szmukler and Rose, 2013; Lee et al., 2017). The development of recovery-orientated
care has fuelled a critique of the role risk plays in decision making and the impact it has on
creating unnecessary restrictions alongside inhibiting individuals’opportunity for recovery
(Stickley and Felton, 2006; Szmukler and Rose, 2013). Services are being challenged to develop
a new approach to risk which facilitates safety whilst moving away from the focus on the
perceived harms caused by people with mental health problems (Boardman and Roberts, 2014)
and facilitates greater opportunity and choice for individuals. This paper draws on narrative
theory to examine the potential of narrative as a means to move towards a co-produced
understanding of risk and safety.
Risk and other
The assessment of risk emphasises categorisation, in which something is recognised and rated
as a potential cause of harm (Higgins et al., 2016). Within mental health care it is a process which
all people who use services are exposed to Langan (2010). Risk assessment disproportionately
emphasises the risks of harms caused by the service user. Social theories of risk can contribute
to understanding how this arises as they highlight how risks are selectively recognised (Douglas
and Wildavsky, 1982; Lupton, 2013). The concept of “Otherness”has been adopted to examine
the process by which some risks are emphasised in society whilst others are ignored. Douglas
Received 22 June 2017
Revised 3 November 2017
Accepted 7 November 2017
Anne Felton and Theo Stickley
are Associate Professors, both
at the School of Health
Sciences, University of
Nottingham, Nottingham, UK.
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THE JOURNAL OF MENTALHEALTH TRAINING, EDUCATION AND PRACTICE
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VOL. 13 NO. 1 2018, pp.54-62, © Emerald Publishing Limited, ISSN 1755-6228 DOI 10.1108/JMHTEP-06-2017-0043
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