Author: Stephen Finlayson
Stephen Finlayson has worked for many years in developing person-centred supports for people with complex disabilities. Increasingly he has noticed that the paradigm of risk, including risk enablement, dehumanises complex problems and drives interventions that harm people’s lives. Here he argues it is time to use ordinary language that creates ordinary responses - to stop worrying about risk - and start talking about our worries.
Risk has arguably become one of the dominant themes in modern social care. Get any group of social care workers together and if one of them trips up you can be sure the joke will come out about whether a risk assessment has been done. It is a joke that reveals both the dominance of risk as a paradigm and the cynicism with which it is often viewed. There has been recognition in recent years that this has become problematic and much of this has attempted to change the focus on to the concept that taking risks can also be positive and thus the concept of “risk enablement” has come to prominence. This has been a well intentioned attempt to redress the balance in services which in so many cases had come to view their role as primarily to ensure no possible harm could ever arise. Or perhaps more accurately, no harm for which they could be blamed.
I wish to propose that attempts to reframe risk through the lens of enablement are unlikely to have a big impact as the entire paradigm of risk is one which inherently drives low tolerance of any possibility of things going wrong – the paradigm is ill suited to social care and needs to be challenged and rethought. The risk enablement theory is a very positive step forward in its highlighting of the weakness of the current model. But it still creates a confused and ambiguous concept that on the one hand thinks of risk as something to be managed and avoided and on the other encourages its promotion. That is not a recipe for clarity in helping people to have good lives.
The ultimate job of anyone working with people whose lives have been characterised by exclusion is to support them to have a good life. One that ensures their human rights and nourishes their ability to build relationships and skills at deciding their own ways of being safe. The entire concept of risk assessment, including risk enablement is a model that grants the authority to the professional and creates a duty to intervene.
It tends to be overlooked how relatively new the concept of risk assessment in social care is. Prior to the 1990’s and the emerging statutory regulation, there was very little concept of risk assessment around individuals. As regulation has come to the fore and brought with it concepts from industrial health and safety, the paradigm of risk, and the duty of providers to carry out risk assessments about people has become enshrined quickly and without enough question. In particular it is worth asking whose interests are served by the risk assessment model. Risk assessment conjures images of neutral objectivity and balance. Deborah Lupton argues that risk is a far from neutral concept which serves the purpose of giving a veneer of scientific authority to decisions which in reality often have powerful political and social interests underpinning them (Lupton 1993). It creates processes and calculations that allow professionals to demonstrate that they have not been negligent in their role. Its primary function arguably is to demonstrate professional competence and allow minimisation of professional liability - not to enhance the individual’s life which the assessment is about. More, it is a model full of dehumanising, clinical language such as assessment, intervention and measurement scores. This cannot be a good way of working for those who believe we must start from a basis of human rights, citizenship and working with people to have good lives.
In recent years I have seen far too many examples of people’s lives severely hampered by the driving focus of their “support” being on perceived risk. A young man who was independently working, highly successfully in a responsible role three days a week but surrounded by a much resented 24/7 support package the rest of the time due to fears of past behaviours. The focus had been entirely on what he had done in the past, not on his evidentially substantial skills and how to further develop them. Another man never allowed to go out in his own car without the rarely available second staff member because he occasionally rocked too much, and never allowed in a supermarket because he once knocked something over. All simple human problems with simple solutions that took many, many months to unpick from the risk assessed quagmire they had become stuck in.
The focus on assessment also creates a perverse waste of staff time in creating documents called risk assessments. My experience suggests these are frequently bureaucratic exercises designed purely to allow compliance with statutory requirements. The real thinking about areas people are worried about goes on as an ever evolving, creative process of relationships, dialogue, planning, mistakes and trying again. The risk assessment process attempts to provide a façade of scientific calculation and certainty to decisions that are inherently complex, often messy and fast changing and that may have few simple answers. They are in short human problems and risk and the language and processes surrounding it is an ideology which dehumanises and industrialises people’s lives.
So what instead? How do we challenge the dehumanising concept of risk?
The first step is to recognise that many individuals, families, thinkers and services have been successfully working together for many years to think through how to approach areas of life people worry about. There is no reinvention of the wheel needed – people in the person centred traditions have developed many ways of working that can support everyone to think meaningfully about what works best for them. Surely the answer as ever is to strip back, to return to ordinary language and ordinary ways of doing things. There is much talk, (and unfortunately further jargon) about outcomes at present, but the focus on what really matters to people is certainly welcome. Any conversation which focuses on what matters to people will inevitably also discuss fears and anxieties, both of the individual and those who love them. But crucially it will focus on them in the context of the bigger picture, of what really matters to the person. That will be the driver, not managing a risk. In my work recently we have had conversations as simple as, what are we worried about? How worried are we? What can we do to worry less? This is not just a semantic difference to what is the risk/How serious is the risk? The very paradigm of risk drives expectations of management and intervention. Talk of human worries drives relationships and discussion. Take a young person wishing to go out clubbing till 3am, perhaps even wanting to get very drunk with friends. Their mum is worried sick. A risk assessment approach will view the young person and what they wish to do as the issue needing assessed and fixed and suggest interventions. A human worries approach will recognise people are worried and facilitate conversation – what can we do to worry less is a very different conversation to how do we manage the risk. All it may do is recognise that mums worry and help mum to manage her anxieties. The resulting actions may be very different, or they may be the same as a traditional risk assessment would have come up with. My experience however would suggest that if the person had a learning disability, many risk assessments would have created a strong intervention. Even were the actions the same, the process of getting there through natural conversations about human worries would be one much more likely to foster relationships, natural solutions and develop the persons skills to manage the situation themselves.
There is a need to be brave and work with commissioners and regulators to create a culture that trusts in the ability of natural human relationships and conversations to come up with better, more life enhancing solutions to human worries than mechanistic risk assessment processes ever will. It is time to stop talking about risk and to start talking about good lives and the natural worries that are part and parcel of them.
The publisher is The Centre for Welfare Reform.
Stop Worrying About Risk © Stephen Finlayson 2015.
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