Understanding Positive Risk Management : A Qualitative Investigation

Skinner, Mollie and Palmier-Claus, Jasper and Sellwood, Bill (2024) Understanding Positive Risk Management : A Qualitative Investigation. PhD thesis, Lancaster University.

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Abstract

This thesis focuses on exploring positive risk management (PRM) within mental healthcare. Section one is a realist review which aimed to understand the contexts and resulting mechanisms by which PRM may work, or not work, within mental healthcare settings. A systematic search of empirical literature across five databases, alongside a grey literature search, returned 20 eligible papers for inclusion. Analysis resulted in eight context, mechanism, outcome (CMO) configurations pertaining to two key theory areas: quality of life and risk. The review suggests there are several key contexts and resulting mechanisms acting as barriers of facilitators to the implementation of PRM within mental healthcare settings including access to relevant staff support and training, pressures and lack of resource in services, personal views on risk acuity and over reliance on structured risk tools. Findings highlight the need for increased staff support and clearer guidance for services to adopt a PRM approach. Future research should focus on testing and refinement of initial theories. Section two outlines an empirical study which aimed to qualitatively explore how staff working in adult community mental health services experience, understand and utilise PRM. Twelve professionals from community services took part in semi structured interviews and data was analysed using reflexive thematic analysis. Three themes were identified: ‘The System: Working With us or Against us?’, ‘Internal States’ and ‘Staff and Service Users: Working Together to Drive Recovery’. Findings suggest the ability to safely and effectively use PRM was influenced by several factors including systemic level pressures impacting staff’s emotional well-being and confidence, with connection and togetherness acting as a key facilitator of a collaborative, PRM approach. Future research involving the service user voice is recommended. Section three details the critical appraisal which discusses the process of completing this thesis, considering decisions, personal reflections and challenges encountered.