title: The many faces of risk: a qualitative study of risk in outpatient involuntary treatment.
abstract: OBJECTIVE
  This study aimed to derive a conceptualized model 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 were analyzed by using a general inductive method.
  
  
  RESULTS
  Six types of risk were identified: actual harm, social adversity, therapeutic outcome or compromised treatment, the system, interpersonal distress, and epistemic issues. There were overlaps between discourses on risk but variation in how different aspects of risk were emphasized by participant groups.
  
  
  CONCLUSIONS
  A comprehensive model of risk contextualized to outpatient involuntary treatment is proposed. It incorporates 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.
authors.affiliation: Ms. Light, Prof. Robertson, Dr. Ryan, and Prof. Kerridge are with the Centre for Values, Ethics and the Law in Medicine, Prof. Boyce, Prof. Hunt, and Dr. O'Connor are with the Discipline of Psychiatry, and Prof. Carney is with the Law Faculty, all at the University of Sydney, Sydney, New South Wales, Australia (e-mail: edwina.light@sydney.edu.au). Prof. Rosen is with the School of Public Health, University of Wollongong, Wollongong, New South Wales, and with the Mental Health Commission of New South Wales, Gladesville. Prof. Cleary is with the School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales.
authors.forename: Edwina
authors.initials: E
authors.lastname: Light
authors.affiliation: Ms. Light, Prof. Robertson, Dr. Ryan, and Prof. Kerridge are with the Centre for Values, Ethics and the Law in Medicine, Prof. Boyce, Prof. Hunt, and Dr. O'Connor are with the Discipline of Psychiatry, and Prof. Carney is with the Law Faculty, all at the University of Sydney, Sydney, New South Wales, Australia (e-mail: edwina.light@sydney.edu.au). Prof. Rosen is with the School of Public Health, University of Wollongong, Wollongong, New South Wales, and with the Mental Health Commission of New South Wales, Gladesville. Prof. Cleary is with the School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales.
authors.forename: Michael
authors.initials: M
authors.lastname: Robertson
authors.affiliation: Ms. Light, Prof. Robertson, Dr. Ryan, and Prof. Kerridge are with the Centre for Values, Ethics and the Law in Medicine, Prof. Boyce, Prof. Hunt, and Dr. O'Connor are with the Discipline of Psychiatry, and Prof. Carney is with the Law Faculty, all at the University of Sydney, Sydney, New South Wales, Australia (e-mail: edwina.light@sydney.edu.au). Prof. Rosen is with the School of Public Health, University of Wollongong, Wollongong, New South Wales, and with the Mental Health Commission of New South Wales, Gladesville. Prof. Cleary is with the School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales.
authors.forename: Philip
authors.initials: P
authors.lastname: Boyce
authors.affiliation: Ms. Light, Prof. Robertson, Dr. Ryan, and Prof. Kerridge are with the Centre for Values, Ethics and the Law in Medicine, Prof. Boyce, Prof. Hunt, and Dr. O'Connor are with the Discipline of Psychiatry, and Prof. Carney is with the Law Faculty, all at the University of Sydney, Sydney, New South Wales, Australia (e-mail: edwina.light@sydney.edu.au). Prof. Rosen is with the School of Public Health, University of Wollongong, Wollongong, New South Wales, and with the Mental Health Commission of New South Wales, Gladesville. Prof. Cleary is with the School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales.
authors.forename: Terry
authors.initials: T
authors.lastname: Carney
authors.affiliation: Ms. Light, Prof. Robertson, Dr. Ryan, and Prof. Kerridge are with the Centre for Values, Ethics and the Law in Medicine, Prof. Boyce, Prof. Hunt, and Dr. O'Connor are with the Discipline of Psychiatry, and Prof. Carney is with the Law Faculty, all at the University of Sydney, Sydney, New South Wales, Australia (e-mail: edwina.light@sydney.edu.au). Prof. Rosen is with the School of Public Health, University of Wollongong, Wollongong, New South Wales, and with the Mental Health Commission of New South Wales, Gladesville. Prof. Cleary is with the School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales.
authors.forename: Alan
authors.initials: A
authors.lastname: Rosen
authors.affiliation: Ms. Light, Prof. Robertson, Dr. Ryan, and Prof. Kerridge are with the Centre for Values, Ethics and the Law in Medicine, Prof. Boyce, Prof. Hunt, and Dr. O'Connor are with the Discipline of Psychiatry, and Prof. Carney is with the Law Faculty, all at the University of Sydney, Sydney, New South Wales, Australia (e-mail: edwina.light@sydney.edu.au). Prof. Rosen is with the School of Public Health, University of Wollongong, Wollongong, New South Wales, and with the Mental Health Commission of New South Wales, Gladesville. Prof. Cleary is with the School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales.
authors.forename: Michelle
authors.initials: M
authors.lastname: Cleary
authors.affiliation: Ms. Light, Prof. Robertson, Dr. Ryan, and Prof. Kerridge are with the Centre for Values, Ethics and the Law in Medicine, Prof. Boyce, Prof. Hunt, and Dr. O'Connor are with the Discipline of Psychiatry, and Prof. Carney is with the Law Faculty, all at the University of Sydney, Sydney, New South Wales, Australia (e-mail: edwina.light@sydney.edu.au). Prof. Rosen is with the School of Public Health, University of Wollongong, Wollongong, New South Wales, and with the Mental Health Commission of New South Wales, Gladesville. Prof. Cleary is with the School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales.
authors.forename: Glenn
authors.initials: G
authors.lastname: Hunt
authors.affiliation: Ms. Light, Prof. Robertson, Dr. Ryan, and Prof. Kerridge are with the Centre for Values, Ethics and the Law in Medicine, Prof. Boyce, Prof. Hunt, and Dr. O'Connor are with the Discipline of Psychiatry, and Prof. Carney is with the Law Faculty, all at the University of Sydney, Sydney, New South Wales, Australia (e-mail: edwina.light@sydney.edu.au). Prof. Rosen is with the School of Public Health, University of Wollongong, Wollongong, New South Wales, and with the Mental Health Commission of New South Wales, Gladesville. Prof. Cleary is with the School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales.
authors.forename: Nick
authors.initials: N
authors.lastname: O'Connor
authors.affiliation: Ms. Light, Prof. Robertson, Dr. Ryan, and Prof. Kerridge are with the Centre for Values, Ethics and the Law in Medicine, Prof. Boyce, Prof. Hunt, and Dr. O'Connor are with the Discipline of Psychiatry, and Prof. Carney is with the Law Faculty, all at the University of Sydney, Sydney, New South Wales, Australia (e-mail: edwina.light@sydney.edu.au). Prof. Rosen is with the School of Public Health, University of Wollongong, Wollongong, New South Wales, and with the Mental Health Commission of New South Wales, Gladesville. Prof. Cleary is with the School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales.
authors.forename: Christopher James
authors.initials: CJ
authors.lastname: Ryan
authors.affiliation: Ms. Light, Prof. Robertson, Dr. Ryan, and Prof. Kerridge are with the Centre for Values, Ethics and the Law in Medicine, Prof. Boyce, Prof. Hunt, and Dr. O'Connor are with the Discipline of Psychiatry, and Prof. Carney is with the Law Faculty, all at the University of Sydney, Sydney, New South Wales, Australia (e-mail: edwina.light@sydney.edu.au). Prof. Rosen is with the School of Public Health, University of Wollongong, Wollongong, New South Wales, and with the Mental Health Commission of New South Wales, Gladesville. Prof. Cleary is with the School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales.
authors.forename: Ian
authors.initials: I
authors.lastname: Kerridge
mesh_terms: D000553:Ambulatory Care; D001008:Anxiety Disorders / Q000628:therapy; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001714:Bipolar Disorder / Q000628:therapy; D017028:Caregivers; D003134:Commitment of Persons with Psychiatric Disorders; D003156:Community Mental Health Services; D003866:Depressive Disorder / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008962:Models, Theoretical; D009517:New South Wales; D036301:Qualitative Research; D012306:Risk; D012559:Schizophrenia / Q000628:therapy; D016728:Self-Injurious Behavior; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014754:Violence