Rethinking risk: a narrative approach

Felton, Anne; Stickley, Theodore

doi:10.1108/jmhtep-06-2017-0043

Cited by 14 publications

(21 citation statements)

References 41 publications

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“…Contrary to developments in general hospital care, there has been little parallel research into the identification of safety issues in mental health care services. Research into patient safety in mental health care has been dominated by the process of individual risk assessment with a focus on the prevention of suicide and homicide, an approach that can be incompatible with recovery‐orientated mental health care . Recent evidence has shown this individual risk assessment frequently does not involve the service user and their families and thus does not take into account their priorities .…”

Section: Introductionmentioning

confidence: 99%

A cross‐sectional survey of mental health service users’, carers’ and professionals’ priorities for patient safety in the United Kingdom

Berzins

Baker

Brown³

et al. 2018

Health Expectations

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BackgroundEstablishing patient safety priorities in psychiatry has received less international attention than in other areas of health care. This study aimed to identify safety issues as described by people in the United Kingdom identifying as mental health service users, carers and professionals.MethodsA cross‐sectional online survey was distributed via social media. Identified safety issues were mapped onto the Yorkshire Contributory Factors Framework (YCFF) which categorizes factors that contribute to patient safety incidents in general hospital settings. Service user and carer responses were described separately from professional responses using descriptive statistics.ResultsOne hundred and eighty‐five responses from 95 service users and carers and 90 professionals were analysed. Seventy different safety issues were identified. These were mapped onto the 17 existing categories of the YCFF and two additional categories created to form the YCFF‐MH. Most frequently identified issues were as follows: “Individual characteristics” (of staff) which included competence and listening skills; “Service process” that contained concerns about waiting times; “Management of staff and staffing levels” dominated by staffing levels; and “External policy context” which included the overall resourcing of services. Professionals identified staffing levels and inadequate community provision more frequently than service users and carers, who in turn identified crisis care more frequently.ConclusionsThis study updates knowledge on stakeholder perceived safety issues across mental health care. It shows a far broader range of issues relating to safety than has previously been described. The YCFF was successfully modified to describe these issues and areas for further coproduced research are suggested.

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Section: Introductionmentioning

confidence: 99%

A cross‐sectional survey of mental health service users’, carers’ and professionals’ priorities for patient safety in the United Kingdom

Berzins

Baker

Brown³

et al. 2018

Health Expectations

View full text Add to dashboard Cite

show abstract

“…This method includes the analysis of the narrative text characteristics, and recently the ones of the meaning of inter-human relations in social, historical, and cultural contexts [Hoshmand, 2005;Felton & Stickley, 2018]. It focuses on people's narratives either about themselves or about a set of events.…”

Section: Narrative Researchmentioning

confidence: 99%

Qualitative Research Methodology in Social Sciences and Related Subjects

Mohajan

2018

JEDEP

908

445

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Abstract. This literature review paper discusses the proper use of qualitative research methodology to discuss several research aspects for the improvement of the readers' skill. During the last few decades, the use of qualitative research has been increased in many institutions. It can be used to explore several areas of human behavior for the development of organizations. The purpose of this study is to provide inspirations to the new researchers for the development of their qualitative articles. The paper analyzes the design of qualitative research giving some methodological suggestions to make it explicable to the reader. In thispaper, an attempt has been taken to study the background of the qualitative research methodology in social sciences and some other related subjects, along with the importance, and main features of the study.

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“…Participants’ loss of connection with individuals’ subjective experiences resulting in a process of objectification is counter to a recovery philosophy and suggests that despite appearances recovery‐orientated practices are limited at the study site. Objectification contributes to the conditions where people with mental health problems can be constructed as dangerous and therefore as “risky” other and contradicts the relational focus of mental health nursing (Felton & Stickley, ; Felton et al., ). It forms one key aspect of a process which enables service users to be defined as risk objects (Hilgartner, ).…”

Section: Discussionmentioning

confidence: 99%

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

Felton

Repper

Avis

2018

Psychiatric Ment Health Nurs

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Accessible summary What is known on the subject? Risk assessment and management in mental health services are contested and perceived as problematic by both professionals and service users. There is substantial emphasis on risk as a core component of professional practice. However, recovery for people with mental health problems emphasizes self‐determination which seems to conflict with risk management. A critique is emerging of risk assessment and management. However, there is a lack of empirical evidence which seeks to explore how professionals manage the conflicts between recovery orientated practice and risk management. What the paper adds to existing knowledge? The paper reports on qualitative research which highlights people with mental health problems are objectified and frequently associated with the potential for harm. Risk dominates the work of mental health professionals and undermines individualized care. Service users are subject to increased surveillance and medication as a result. What are the implications for practice? Service users’ subjective experiences need to be prioritized in mental health care by renewed focus on the relationship between professionals and service users. Mental health professionals should question the centrality of risk to their practice. Abstract IntroductionThe emergence of recovery, alongside significant focus on risk management, creates potential for conflicting influences in mental health care. Although evidence has critiqued risk assessment, there is a lack of research that seeks to explore how professionals make decisions within these apparently incompatible agendas. AimTo explore how practitioners, experience potential tensions arising from delivering recovery‐orientated care and enforcing containment. MethodThis paper reports on a case study inquiry, using interviews with mental health professionals and observations in an acute ward and an assertive outreach team. ResultsRisk governed the practice of mental health professionals to such an extent it defined how service users were understood and treated. Service users were constructed as objects of risk, first by being objectified and secondly by creating a link between that object and harm. DiscussionHilgartner's (1992, Organizations, uncertainties and risk (pp. 39–53). Boulder, CO: Westview Press) theory of risk explains how risk dominates the identity of people with mental health problems at the cost of recovery. This results in increased monitoring, surveillance and medication to enact control. Implications for practiceTo undermine the dominance of risk, professionals should reconnect with the subjective experiences of people with mental health problems and challenge the acceptance of risk as central to their role.

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Rethinking risk: a narrative approach

Cited by 14 publications

References 41 publications

A cross‐sectional survey of mental health service users’, carers’ and professionals’ priorities for patient safety in the United Kingdom

A cross‐sectional survey of mental health service users’, carers’ and professionals’ priorities for patient safety in the United Kingdom

Qualitative Research Methodology in Social Sciences and Related Subjects

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

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