Dignity in Risk & Risk of Harm

Unquestionably, the spectrum between negligence and overprotection carries with it serious implications in clinical & peer professional practice in mental health. Even in our personal lives, we have friends and family we care for and we wonder where the line is drawn when it comes to caregiving or caring for a friend struggling to maintain their own safety living independently. For therapists, peers, & psychiatrists, the landscape between the two poles of negligence and overprotection is even more unclear, sometimes, and in-dispute for interdisciplinary teams with workers from different ethical stances.

Dignity of Risk

Dignity of Risk is understood by most practitioners and peers as the chance, choice, or possibility of a patient failing in their goals or capacity to self-manage independently. It means there is a level of self-worth cultivated by people when they are left to their own devices to make choices for themselves. Call it self-esteem, or self-respect; people generally feel better about themselves when they are given the opportunity to fail at whatever it is they set out to do.

The Problem

The problem with complete autonomy and “free-will” when you’re in treatment is twofold: 1) Treatment is a contract between a provider and patient which carries with it the assumption of adherence and/or active participation in their own care. 2) Without any oversight from a provider, therapists, peers, and psychiatrists will run the risk of committing negligence or malpractice should something unforeseen happen to a client that may have been preventable should the client have been monitored and in active treatment.

The Limits of the Law

The limits of the law are clear. Every state in the United States has a regulatory body that decides where this line is drawn between negligence and dignity of risk for therapists and psychiatrists. Peers Professionals too, are working on actively drawing up plans to manage risk more effectively to reduce the likelihood of harm to clients and collaborate more closely with their clinical counterparts.

The Disconnect

The law is written and very clear on paper so we abide by it in practice. The liminal space between theory and practice or praxis is where the line gets blurred when deciphering what to do with a client when their risk of homicidal or suicidal behavior is unclear, or unable to be assessed.

In situations like this, besides your “gut” feeling, on which side of the negligence versus overprotection spectrum do your instincts tell you to side?

What will inform your choice;

1) will it be the relationship you have with your patient,
2) Their apparent mental status
3) Their level of mental distress
4) The level of trust between you and your client

More importantly, what does it say for you as a practitioner when you make your decision?

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