Mental health: Look Ahead Housing and Care

The easiest way to minimise risk-taking when working with the most vulnerable client groups, such as people with dual personality disorders, paedophiles and people with severe mental health problems, is to institutionalise them.

We can control their medication, their freedom and their lives, but it is not a long-term solution.

If the pressure of day-to-day work can make risk-review meetings seem to be a low priority, failing to address risk can have serious repercussions. Official enquiries into incidents inevitably seek to identify blame.

So it is not surprising that while those who participated in our recent research on the issue believed in positive risk-taking, many worried about the consequences of decisions.

Risk cannot be eliminated from supported housing schemes, but a clear understanding of risk control processes can promote safety.

We have recently opened one of six pilot projects which house and rehabilitate people with dual personality disorders who have been in a forensic unit - offenders who have not been imprisoned because of their mental ill-health. These are often some of the most politically unpopular client groups and new initiatives to house and provide services to them in the community can result in strong public reactions.

The pilots are a response to the Department of Health's 2003 guidance, Personality Disorder: no longer a diagnosis of exclusion, and offer some of the few opportunities for people in this client group to live a 'normal', uninstitutionalised life.

Local research showed that we could more than fill the rooms with clients who fit the criteria. Yet when it came to receiving new referrals, over-caution from a range of professionals was the biggest barrier.

To rise to the challenge of moving people on from long-term stay in hospitals into the community, the health sector will have to embrace positive risk-taking and work closely with independent providers.

Chris Hampson is director of strategy and performance at Look Ahead Housing and Care. chrishampson@lookahead.org.uk