1. Service Users subject to s. 41 of the Mental Health Act 1983 - Their views of risk and risk assessments Jeremy Dixon

2. Introduction This research aims to explore the views of service users subject to s. 41 of the Mental Health Act 1983. The research is qualitative. The research aims to focus on user views related to risk and risk assessment.

3. Service User views about Risk Assessment.

4. Purpose of Risk Assessment The majority of respondents were either not aware of the existence of a risk assessment or could not recall its content. ◦Interviewer: Can you remember what was in the document [the risk assessment] ◦Participant 2: Not really, no.

5. Construction of Risk Assessments The majority of service users were not sure how risk assessments were constructed. Of those who were aware of a risk assessment, the majority felt that their assessments were constructed by a multi- disciplinary team within Care Program Approach Meetings. One service user thought that his risk assessment had been formed by his doctor. One service user felt that the process was formed in coalition with him.

6. Construction of Risk Assessments Overall, service users feel that they have very little influence in changing staff views of their risks. Participants generally felt that their disagreements would be noted but that this made little difference to the existing assessment. Two participants felt that a period of non- risky behaviour might alter their assessments. However, this was generally seen as a long process.

7. Construction of Risk Assessments Interviewer: What would happen to the risk assessment if you didn’t do any of those things? Participant 8: It would go down in stages, they have four boxes, low, moderate, high, very high and it would go down to low. Interviewer: How long before it would go down to low? Participant 2: Don’t know. All my life knowing how strict these places are.

8. Views of professionals’ risk judgements

9. Service users tended to have clear opinions about how the professionals involved in their care viewed their risks. Their conceptions of professional views were often seen in conjunction with professional powers such as recall. Most service users viewed professionals as holding a “safety first” ethic. One user highlighted an example of staff advocating for his risks to be dealt with outside of the order. Another felt that staff views about risk were motivated by malevolence.

10. Views of professionals’ risk judgements “…he [the psychiatrist] would make sure that I was in the safest place possible and if he wanted to, if he determined that I was mentally unstable or not managing myself properly he would undoubtedly ask for me to be recalled to hospital.” – Participant 4.

11. Service User Views of their own risks

12. All but one of the participants accepted that they had constituted a risk at some time. None of the participants felt that they were currently a risk to themselves or others. Rationales for reduced risk included: ◦Receiving medical or psychological treatment ◦Change in lifestyle ◦Changes in thinking

13. Service User Views of their own risks “I’m just a guy who got ill and did something stupid that I wouldn’t of done in my right state of mind” – Participant 1 “I think the risk is going down because I want it to go down like I said I got more support now and I can talk to people, like before it would be get angry self harm, and now it’s get angry and talk about it and lower the risk of that” – Participant 7

14. Service User Views of their own risks Interviewer: Can you pinpoint what makes you less violent? Participant 8: When you grow older and mature violence doesn’t seem necessary, clearer, intelligent ways of dealing with life and other human beings. Interviewer: There are other ways of sorting your problems out? Participant 8: Yes, diplomacy, democracy, love in your life, respect, brotherly love and stuff.

15. Summary

16. Summary A large proportion of service users are not aware whether they have a risk assessment or cannot remember what is in it. Those who are engaged with it tend to see it as having either a contractual, a historical or a pragmatic purpose. Most service users feel that they have little influence over their risk assessment. Service users have clear ideas about how professionals view their risks. Most service users feel that they have constituted a risk in the past but do so no longer. They attribute this to treatment, changes in lifestyle and changes in thinking.