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Risk assessment practice within primary mental health care: A logics perspective

Flintoff, Adam and Speed, Ewen and McPherson, Susan J (2019) 'Risk assessment practice within primary mental health care: A logics perspective.' Health, 23 (6). pp. 656-674. ISSN 1363-4593

Flintoff Speed McPherson 2018 - Accepted version.pdf - Accepted Version

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From the 1980s onwards, discourses of risk have continued to grow, almost in ubiquity. Ideas and practices of risk and risk aversion have extended to UK mental health care where services are expected to assess and manage risks, and high-quality clinical assessment has been revised to incorporate risk assessment. This article problematises practices of risk assessment in mental health provision, focussing on the base-rate problem. It presents an analysis of audio recordings of risk assessments completed within a primary care mental health service. The analysis is informed by a critical logics approach which, using ideas from discourse theory as well as Lacanian psychoanalysis, involves developing a set of logics to describe, analyse and explain social phenomena. We characterise the assessments as functioning according to social logics of well-oiled administration and preservation, whereby bureaucratic processes are prioritised, contingency ironed out or ignored, and a need to manage potential risks to the service are the dominant operational frames. These logics are considered in terms of their beatific and horrific fantasmatic dimensions, whereby risk assessment is enacted as infallible (beatific) until clients become threats (horrific), creating a range of potential false negatives, false positives and so forth. These processes function to obscure or background problems with risk assessment, by generating practices that favour and offer protection to assessors, at the expense of those being assessed, thus presenting a challenge to the stated aim of risk assessment practice.

Item Type: Article
Uncontrolled Keywords: base-rate problem, discourse theory, logics, primary care, risk assessment
Subjects: R Medicine > RA Public aspects of medicine > RA790 Mental Health
Divisions: Faculty of Science and Health
Faculty of Science and Health > Health and Social Care, School of
SWORD Depositor: Elements
Depositing User: Elements
Date Deposited: 20 Apr 2018 12:14
Last Modified: 18 Aug 2022 13:22

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