15 - Managing risk

Summary

The management of risk is not an isolated task. It is an intrinsic part of the work of mental health professionals, and it runs as a continuous theme through all aspects of practice. It involves complexities and ambiguities, and it nearly always involves balancing one type of risk against another (for example, the greater safety achieved by admitting someone to hospital may cause significant long-term problems in other aspects of their life).

Mental health professionals frequently cite risk management as the aspect of their work that causes them greatest anxiety. Risk management was once a matter of professional duty, but this has given way to a more personal type of accountability, whether through litigation or through adverse incident investigations. It is very hard to judge how effective individual practitioners are at identifying and managing risk, because serious incidents occur infrequently. You never know if you have prevented an adverse event. We know from personal experience that, when something bad does happen, defensiveness and guilt cloud your judgement as to whether you could or should have done something differently. Western societies have become markedly intolerant of risk, but no system of care could ever eliminate it. This means that conscientious practitioners will sometimes find themselves criticised or penalised because treatment plans have gone awry. We all have to live with this.

These circumstances create two major pitfalls for mental health professionals.