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

Area of Science:

• Psychology
• Sociology
• Health Services Research

Background:

• Risk discourses have become ubiquitous since the 1980s.
• UK mental health services increasingly incorporate risk assessment into clinical practice.
• This study examines the problematization of risk assessment practices in mental health.

Purpose of the Study:

• To critically analyze risk assessment practices in UK primary care mental health services.
• To investigate the influence of the "base-rate problem" on mental health risk assessments.
• To explore the social logics underpinning risk assessment procedures.

Main Methods:

• Analysis of audio recordings of risk assessments from a primary care mental health service.
• Application of a critical logics approach, integrating discourse theory and Lacanian psychoanalysis.
• Development of specific logics to describe and analyze social phenomena within risk assessments.

Main Results:

• Risk assessments function according to social logics of "well-oiled administration" and "preservation."
• Bureaucratic processes and service risk management are prioritized over client needs.
• These logics create "beatific" (infallible) and "horrific" (client as threat) dimensions, leading to potential inaccuracies like false negatives/positives.

Conclusions:

• Risk assessment practices in mental health can obscure inherent problems by prioritizing assessor protection.
• The current framework may disadvantage individuals being assessed, challenging the stated aims of risk assessment.
• Re-evaluation of risk assessment protocols is needed to ensure client welfare and accurate evaluation.