Can we risk recovery? A grounded theory of clinical psychologists' perceptions of risk and recovery-oriented mental health services.

OBJECTIVES: This study sought to explore the views of clinical psychologists towards the concepts of 'risk' and 'recovery' and to set those views against the context of mental health services.

DESIGN: An exploratory, social constructionist grounded theory methodology was adopted.

METHODS: Eleven clinical psychologists working in adult mental health services each participated in one individual semistructured interview.

RESULTS: The clinical psychologists studied were aware of the emergence of recovery-oriented approaches, but felt unable to incorporate them in practice because of perceptions of being bound by both their own limitations and those of their circumstances, including issues of risk, thus giving rise to dilemmas in professional practice. Narrow definitions of risk as equated to danger dominated over broader conceptualizations of risk with positive consequences. The existing culture of mental health services was seen as emphasizing the need to avoid harmful consequences of taking risks, which in turn was seen to limit innovations in implementing recovery-oriented approaches.

CONCLUSIONS: Participants' ability to work in a recovery-oriented manner seemed to be limited by the way in which services perceived and responded to risk. Participants did not discuss risks arising from stigma, social exclusion, racism, sexism, or iatrogenic effects of psychiatric treatment. Narrow conceptualizations of risk as related to harm and danger seen in this study contribute to a sense of needing to be risk averse. However, the implications for practice included ideas about what might increase the possibilities for adopting recovery approaches across disciplines.