Intended for healthcare professionals

Rapid response to:

Head To Head Maudsley Debate

Does the emphasis on risk in psychiatry serve the interests of patients or the public? No

BMJ 2013; 346 doi: (Published 12 February 2013) Cite this as: BMJ 2013;346:f857

Rapid Response:

Re: Does the emphasis on risk in psychiatry serve the interests of patients or the public? No

As a practising psychiatrist of over 10 years' experience, I have observed a definite shift towards the management of patients with an ever-increasing emphasis being placed on risk management. There is no doubt that risk assessment and management is a critical component of psychiatric practice, it often feels as if we lose sight of treating the patient's underlying mental illness, and now have a tendency to focus almost exclusively on their risks.

As a consequence, I have observed that it is often the 'riskiest' patients who receive the most attention, and take up the most resources. This is often to the detriment of other patients, who may in fact be more unwell, but do not present with significant risks. Such patients are being neglected in essence. I have seen many patients who as a direct consequence of their illness, have an awful quality of life and functional impairment, but simply because they are not having thoughts of killing themselves or anyone else, we choose to neglect their needs. These attitudes have negatively affected our concept of patient need to the extent distorting our views on the need for detention under the Mental Health Act. Legally, patients should be detained to hospital if they are suffering from a mental illness which may represent 1) a risk to self, 2) a risk to others or 3) a deterioration of their illness if left untreated. When deciding on which course of action to take, I have been amazed at the number of times that i am met with the question of "why on earth do you want to admit them, they're not suicidal or homicidal." It is almost as if we have forgotten about the third criterion completely-we have a duty to provide timely and effective intervention to prevent further deterioration in a patient's underlying mental illness, IRRESPECTIVE of the presence or absence of risk!!

In conclusion, psychiatry's obsession with risk management has come at the expense of patient care based on needs. It has given us an increasingly narrow-minded and myopic view in the way in which we treat our patients, and prevents us from taking a broader perspective of their needs.

Competing interests: No competing interests

23 February 2013
Aashish Tagore
SpR Psychiatry
Mersey Deanery
Brunswick Business Park, Summers Road, Liverpool, L3 4BL