title: The impact of risk management practice upon the implementation of recovery-oriented care in community mental health services: a qualitative investigation.
abstract: BACKGROUND
  Recovery-oriented care has become guiding principle for mental health policies and practice in the UK and elsewhere. However, a pre-existing culture of risk management practice may impact upon the provision of recovery-oriented mental health services.
  
  
  OBJECTIVE
  To explore how risk management practice impacts upon the implementation of recovery-oriented care within community mental health services.
  
  
  METHODS
  Semi-structured interviews using vignettes were conducted with eight mental health worker and service user dyads. Grounded theory techniques were used to develop explanatory themes.
  
  
  RESULTS
  Four themes arose: (1) recovery and positive risk taking; (2) competing frameworks of practice; (3) a hybrid of risk and recovery; (4) real-life recovery in the context of risk.
  
  
  CONCLUSIONS
  In abstract responses to the vignettes, mental health workers described how they would use a positive-risk taking approach in support of recovery. In practice, this was restricted by a risk-averse culture embedded within services. Mental health workers set conditions with which service users complied to gain some responsibility for recovery.
  
  
  CONCLUSIONS
  A lack of strategic guidance at policy level and lack of support and guidance at practice level may result in resistance to implementing ROC in the context of RMP. Recommendations are made for policy, training and future research.
authors.affiliation: a Department of Mental Health , Social Work and Integrative Medicine, Middlesex University , TG69 Ground Floor Town Hall, Hendon Campus, The Burroughs, London , UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Holley
authors.affiliation: b Department of Mental Health Nursing , Faculty of Health, Social Care and Education, Kingston University and St. George's University of London , Cranmer Terrace , London , UK , and.
authors.forename: Mary
authors.initials: M
authors.lastname: Chambers
authors.affiliation: c Department of Social & Community Mental Health , Population Health Research Institute, St George's, University of London , London , UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Gillard
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003156:Community Mental Health Services / Q000458:organization & administration*; D005260:Female; D066296:Grounded Theory; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012308:Risk Management
keywords: Qualitative research; recovery-oriented care; risk management practice