Service user perspectives and experiences of risk assessment and management in an acute psychiatric setting: A critical ethnography

Grundy, Andrew (2022) Service user perspectives and experiences of risk assessment and management in an acute psychiatric setting: A critical ethnography. PhD thesis, University of Nottingham.

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Many mental health policy documents state that involving service users in conversations about risk is important to improving quality of care and promoting recovery. However, a scoping review of the literature revealed limited evidence of service users having a role in the assessment and management of risk. It suggested that service users are unaware, uninvolved, and ill-equipped for, risk assessment and management; particularly in acute psychiatric inpatient settings. The power of staff to define, document, and manage the risks that matter are key factors in explaining service user experience.

Research question:

How do mental health service users experience risk assessment and management in an acute psychiatric inpatient setting?


Data was generated by a service user researcher via four months of intensive, overt, non-participant observation of life on one acute psychiatric ward (47 service users; 35 staff), including formal meetings (ward rounds; community meetings; handovers; one-to-ones) and informal spaces, and via semi-structured interviews (11 service users; 11 staff).


1). Risk is a “sensitive” and “emotive” experience that can be “difficult” for service users to discuss openly.

2). An “honest sharing” of the individual’s experiential knowledge is required to enhance their self-knowledge (identify triggers) and develop new knowledge (coping skills) towards independent coping.

3). Service users feel distant from aspects of formal risk assessment processes and from the knowledge formed, resulting in feelings of powerlessness.

4). Clinical knowledge is prioritised over experiential knowledge in various ways.

5). To counterbalance this perceived power-disparity, service users are seeking more involvement, framed as opportunities to contribute their experiential knowledge.


This research contributes to our understanding of risk as a form of experiential knowledge, and risk assessment and management as epistemic activities. It explores conflicting epistemologies operating in the setting (clinical vs experiential), and the power dynamics involved, which contribute to service users experiencing forms of epistemic injustice. How epistemic justice can be recovered through an interpretivist approach to service user testimony and a coproduction approach to knowledge and power is outlined. That risk documentation can be used (as boundary objects) to navigate these issues of knowledge and power within the setting will be discussed. Implications for practice are that risk processes should be made transparent, one-to-ones routinely initiated by staff, and ward round preparation encouraged. Risk documentation should be co-constructed, to enable service user narratives to be centred in acute psychiatric inpatient risk assessment and management.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Morriss, Richard
Wright, Nicola
Keywords: Mental health service users; Risk assessment; Epistemic justice; Interpretivist approach; Risk processes
Subjects: W Medicine and related subjects (NLM Classification) > WM Psychiatry
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Health Sciences
Item ID: 67390
Depositing User: Grundy, Andrew
Date Deposited: 31 Jul 2022 04:40
Last Modified: 31 Jul 2022 04:40

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