Balancing risk and recovery in mental health: an analysis of the way in which policy objectives around risk and recovery affect professional practice in England

This chapter explores two dominant themes within mental health care today - risk and recovery. Drawing on governmentality theory, the chapter focusses on professional practice in England where there has been an increase in law and policy focussed on risk management since the 1990s. It is argued that public concerns about the perceived risk that people with mental health problems are seen to pose to others has led to a range of ‘safety first’ policies. These policies have promoted the use of standardised risk tools and coercive treatments in the community. However, a focus on risk only tells half the story as the Government has also introduced policy objectives promoting notions of recovery. Whilst the concept of recovery is contested most definitions focus on the subjective experience of service users arguing that they should be able to define what recovery means to them. This poses an implicit challenge to mental health professionals seeking to frame and manage risk. The chapter charts the tensions between these two sets of policy objectives. It is argued that service users are only enabled to define their own recovery in cases where professionals do not view their choices as ‘risky’. The chapter concludes by examining the way in which mental health professionals currently assess and manage risk. The chapter demonstrates that professionals have resisted the use of standardised risk tools. However, policy directives instructing professionals to minimise risk continue to frame professional practice. Consequently, professionals are only able to facilitate service users’ recovery goals in limited circumstances.