Risk, discourse and identity work: what we do and how we could do it differently

It seems that our field of mental health nursing is constantly going over old ground in our attempts to understand and articulate what we do. It is unlikely however that many of us will have missed how our work has become more concerned about risk. We are appropriately worried about preventing harm and promoting safety but also understandably concerned about blame and where it might lie. In the midst of this new focus on what Rose has called ‘risk thinking’ we may be guilty of losing sight of the effect our changing discourses are having on the practice and identity of mental health nursing. Our profession has become concerned with what Godin ruefully notes as ‘ticking the boxes on the form’ both metaphorically and literally. More worrying still is that this very discourse of risk, harm and blame is also having an effect on the people our profession are meant to be helping. Identity, or how we are known to ourselves and to others, is a critical element of everyday impression management. People with enduring mental distress have often come to know themselves as embodying a diagnostic label and have the added burden of various risk labels. Risk and its measurement, we are meant to believe is a new science. However much of what is claimed to occur in risk assessment is little more than fiction; fables for dealing with the terrible uncertainty that both the person and the nurse experience. Standardised measures are largely unreliable and many do not offer the certainty that we so desperately long for. In this lecture I base my analysis on more than 30 years of research and practice as a mental health nurse to explore notions of risk and their effects, highlight the use of discourses on and of risk and how these both limit and alternatively could be used to enhance identity work of individuals and the profession itself. I make the case that new forms of involvement and engagement in discussions about risk are required that more directly align with mental health nursing identities and that will enable people using services to build and sustain agency