Risk as a concept now takes high priority in contemporary mental health services, with increasing pressure on mental health services to develop risk assessment and management practices. This focus on risk has been criticised for its over-reliance on measurement and management at the expense of therapeutic care and is perpetuated by the language of risk which reinforces power differentials and limits capacity for consumers and carers to influence discussions and debates. Furthermore, to date, most work in this area reflects adult settings with limited consideration of the unique needs of older people and the impact of risk assessment on the care they receive. A qualitative, exploratory approach was undertaken using individual interviews and focus groups to enhance understanding of how risk is conceptualised within an older persons' setting. Managers, clinicians, consumers, and carers from a large metropolitan service participated (n = 57). The language of risk was a major theme emerging from this work. This language, so familiar to providers of services, was not familiar to consumers and carers. A reframing of risk is necessary to reflect consumers' and carers' experiences and understandings. This approach will be essential in promoting consumer and carer participation within recovery-based services, reflecting significant goals of government policy.

Risk is commonly defined as a negative threat which needs to be controlled and mitigated; as a concept, it takes high priority in contemporary mental health services. Health-care organizations and clinicians are now required to use levels of risk as a benchmark for clinical decision-making. However, perceptions of risk change according to the lens through which it is viewed. A qualitative, exploratory research study was undertaken in an aged persons' mental health programme in Victoria, Australia, to explore the notion of risk from the multiple perspectives of service providers and consumers. Data were obtained through in-depth interviews, and analysis was based on the framework of Ritchie and Spencer. Balancing uncertainty emerged as a major theme, and comprised two subthemes: (i) complexity of risk from the perspective of providers of services; and (ii) complexity of safety from the perspectives of recipients of services. These differences emphasize a significant disjuncture between perceptions of risk and the potential for the individual needs and concerns of consumers to be subsumed under broader organizational issues. The uncertainty this tension highlights suggests the need to reconceptualize risk, incorporating the views and experiences of all stakeholders, particularly consumers and carers, to enhance recovery-oriented services and facilitate consumer participation within mental health services.

A deeper examination and reconceptualisation of the role and importance of risk in mental health care are needed to ensure the focus of service delivery remains consumer-focused.

cut (n = 5, for each group). The aortic receptors are not chemosensitive in the rabbit (Bouverot et al., 1973, Respiration Physiology, 17, 209).No significant difference in HBF was observed between the two groups of rabbits during the control period or after 15 or 120 min of hypoxia, nor was there any difference in Pa,o, or Pa,co,. In a further group of three rabbits the ventilatory response to the inhalation of 10% 0, was measured before and after carotid sinus nerve section. Before carotid sinus nerve section ventilation increased by 66.65 13.7% (meanksm), after carotid sinus nerve section inhalation of 10% O2 decreased ventilation by 9.5 5 5.4%. This confirms that there is no contribution from aortic receptors to the respiratory response to hypoxia in the rabbit. It is concluded that the changes in HBF observed during hypoxia in the anaesthetized rabbit cannot be attributed to stimulation of the peripheral chemoreceptors by hypoxia. 24. Prolonged hypoxia causes selective hypertrophy of the right ventricle (RV) in animals and man. Hypertrophy of the left ventricle (LV) in hypertensive rats is accompanied by an increase in intracellular pH (pH,) and in intracellular buffering capacity (Saborowski et al., 1973, Respiratory Physiology, 18, 171). There has been no comparison of the effect of chronic hypoxia on pHi in muscle from RV and LV. Groups of up to twenty male rats (Cummins Sprague Europe) were maintained at a constant Po, of either 19.9 5 0.4 kPa or 12.0 k 0.27 kPa (meant SD) in an environmental chamber for 28 days. The mean chamber Pco,was 0.1450.14 kPa for both groups and the average chamber temperatures were similar. Food and water were freely provided. After 28 days the rats were removed from the chamber and anaesthetized with ether. Aortic blood was then sampled while the animal breathed a gas mixture similar to that in the chamber through a mask and muscle was removed from the atria, RV and LV. The extracellular fluid volume (ECFV) was calculated from the distribution volume of [51Cr]EDTA and the pHi measured using the [14C]DM0 technique. The hypoxic rats weighed 386+11 g as opposed to 411 & 25 g for controls (PO.1) nor was there any change in the ECFV of the LV, or atria. The pHI of muscle from each of the heart chambers did not change despite a significant difference in arterial pH (7.47 k0.04 hypoxic group, 7.39 5 0.05 control ; P < 0.001) and arterial Pco, (3.50 ik EXTRACELLULAR SPACE AND INTRACELLU-0-33 kPa hypoxic group, 5.73k0.86 kPa control, P < 0.001) between the groups.These results show that in spite of hypertrophy of the right ventricle in chronic hypoxia, there is no change in ECFV o...