Perception of risk for older people living with a mental illness: Balancing uncertainty

Abstract

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.

Walking with the illness and life: Experience of the community life of people previously under the services of an integrated community mental health service

“…Mental health professionals felt the tension of balancing the need to prevent potential harm to clients in the community (regarding uncertainty) against the provision of appropriate care based on the client's preferences and condition. Although mean age of the clients in this ICCMW study was below 48 years, in contrast to that in the study of Clancy et al (2015), uncertainty was also found among them and their relatives regarding the experience and process of walking with mental illnesses. In lieu of dealing with uncertainty by maximizing the benefits of family presence during such a process in the community, there is a need to further investigate how the family approach to ICMHS support may contribute to increasing the clients’ sense of hope (Bland & Darlington, 2002; Hasson‐Ohayan, Kravetz, Meir, & Rozencwaig, 2009; Redlich, Hadas‐Lidor, Weiss, & Amirav, 2010), subjective well‐being (Werner, 2012) and positivity.…”

“…Nevertheless, during the walk, there were uncertainties in the daily life of discharged clients with regard to seeking jobs, and to being “without a fixed plan” [Nancy]. Another qualitative study of eight older clients (65 or above) with depression, bipolar affective disorder and schizophrenia in a low‐care community hostel, and 22 healthcare professionals (including registered nurses, psychologists, consultant psychiatrists, social workers and occupational therapists), found that their perspective about managing the risk of suicide and violence arising from mental illness was to “balance uncertainty” (Clancy, Happell, & Moxham, 2015). Mental health professionals felt the tension of balancing the need to prevent potential harm to clients in the community (regarding uncertainty) against the provision of appropriate care based on the client's preferences and condition.…”

The experience of growing old in chronic mental health patients

“…Participants identified a number of challenges to adopting healthy aging practices, related to physical health difficulties and medication side effects, lack of purpose and boredom, and conflicts and loss affecting family and peer relationships. These echo previous research findings on challenges facing aging patients with mental illness in areas of physical health and disability and family and social relationships and functioning (Clancy et al, 2015;Clifton et al, 2013;Cummings & Kropf, 2011;Futeran & Draper, 2012;Mueser et al, 2010;Ramaprasad et al, 2015). The current findings also highlight challenges associated with daily routines and use of time, which have been paid less attention in previous research.…”

“…Recent research has indicated significant unmet needs associated with aging and mental illness. However, most research about unmet needs and other issues associated with mental illness focuses on younger, rather than aging, patients (Clancy, Happell, & Moxham, 2015;Cummings & Kropf, 2011;Futeran & Draper, 2012;Ramaprasad et al, 2015). Little research had examined specific experiences of aging with mental illness, probably due to the relatively short life expectancy of patients with mental illness or institutionalization policies in the past.…”

The construction of people with mental health problems as risk objects: Findings of a case study inquiry

“…Professionals are concerned about the influence of risk assessment on their relationship with service users and feel constrained in decision-making, contributing to a tendency to emphasize risk avoidance to maintain safety (Clancy, Happell, & Moxham, 2015;Downes, Gill, Doyle, Morrisey, & Higgins, 2016). Some risks, particularly those associated with violence which are more rare, receive greater attention whilst others such as risks linked to the impact of psychiatric treatment are overlooked (Coffey et al, 2016).…”