The Many Faces of Risk: A Qualitative Study of Risk in Outpatient Involuntary Treatment.

Abstract

Objective: This study aimed to derive a conceptualisation of risk in outpatient involuntary psychiatric treatment that has utility and meaning for stakeholders. Methods: Thirty-eight participants –patients, caregivers, clinicians and legal decision makers – participated in qualitative interviews about their experiences of outpatient involuntary psychiatric treatment. Interview data was analysed using a general inductive method. Results: Six types of risk were identified: ‘actual harm’, ‘social adversity’, ‘therapeutic outcome/compromised treatment’, ‘the system’, ‘interpersonal distress’, and ‘epistemic’. There were overlaps between the discourses on risk, but variation in how different aspects of risk were emphasised. Conclusions: Based on the findings, a comprehensive model of “risk” contextualized to outpatient involuntary treatment is proposed. It incorporates the domains of “risk of harm to self or others”; “risk of social adversity”; “risk of excess distress”; and, “risk of compromised treatment”. This model may have instrumental value in the implementation and the scrutiny of risk-based mental health laws.