Heavey, Tom and Hodge, Suzanne (2017) A qualitative exploration of how risk is conceptualised and worked with in mental health services. PhD thesis, Lancaster University.
2017HeaveyDClinPsy.pdf - Published Version
Available under License Creative Commons Attribution-NoDerivs.
Download (2MB)
Abstract
This thesis explores concept of risk in mental health services via a literature review, research paper and a critical appraisal. The literature review is a qualitative systematic meta-ethnographic study of six papers exploring therapists experiences of working with clients who are suicidal. The findings suggest therapists experience the work as emotionally demanding. Some therapists working with clients who are suicidal, fear blame or emotional discomfort which contributes to them avoiding relational closeness with their clients. The findings imply that therapists’ experiences may vary, with some feeling capable of managing the emotional demands of the work and others experiencing it as overwhelming. The findings highlight the possible benefits of therapists receiving support, including regular clinical supervision. A grounded theory (Glaser & Strauss, 1967; Charmaz, 2006) was constructed from interviews with ten multidisciplinary staff working in older adult 'functional' inpatient mental health services. The grounded theory explains how risk is narrowly conceptualised as something dangerous resulting from perceived 'mental illness'. Staff become focused on the task of risk reduction through the use of medication and electroconvulsive therapy. Potentially, the process of focusing on the task provides a form of psychological defence for staff; against anxieties, tension and distress evoked within them by their work (Menzies-Lyth, 1959). When dangerous risk is reduced occupational therapists conceptualise risk more broadly and work with risk more collaboratively with patients. The critical appraisal extends the discussion of the strengths and limitations of the research project. The challenges of being a novice meta-ethnographer and grounded-theorist are then discussed. Clinical implications from the research paper are also addressed. A compassionate, trauma-informed and collaborative approach to older adult mental health is argued for.