Unsettling the risk discourse: a dialogical narrative analysis of stories from CAMHS

The inadvertent harms stemming from risk management practices in mental health services have been widely highlighted, indicating that a change in approach to managing risk is required. However, suggested changes have tended to disregard the fact that risk is not merely a set of practices, but a discourse. This means that broader questions need to be posed to understand its power and influence; to see not simply what risk is, and how to tackle it, but what risk discourses do, and what they may be inhibiting. This study contributes to a body of literature that is concerned to locate discourses of risk within a wider cultural and political context. The stories of 6 people who have either lived or worked with a young person perceived to be ‘at risk’ of self-harm or suicide within Child & Adolescent Mental Health Services (CAMHS) are analysed using the methods of dialogical narrative analysis. The analysis reveals the multiple discourses at play shaping and influencing how clinicians and families respond when situations are perceived to be risky. The risk discourse is seen to create contradictions that are incompatible with prioritising safety - serving the needs of organisations as opposed to service users or clinicians. The findings indicate that connection, dialogue, and the sharing of expertise, not the eradication of risk, can be important in supporting people to live through difficult and unsafe times. The study concludes that changes need to be considered at a relational level if spaces of resistance to the dominant risk discourse are to be found, and a reframing of expertise is explored as one such potential site. A counter discourse of relational interconnection is thereby offered as a way to foreground safe contexts and safe relationships, as opposed to ‘risk-free’ individuals.