An investigation into how service-users understand the relationship between the risk assessment process and the therapeutic relationship between clinicians and adult mental health service-users in a community setting.

Despite risk assessment being an integral part of mental health care little is known about how service users experience risk assessment. Risk assessment is a relational event, requiring a clinician to gather information from a service-user and therefore requires some level of therapeutic relationship. Evidence suggests that the therapeutic relationship is predictive of therapeutic outcomes. Researchers have started to suggest that risk assessment may have an impact on the therapeutic relationship, but to date no research has specifically explored this. This research aimed to explore how service users experience risk assessment in the context of developing and maintaining a therapeutic relationship in a Community Mental Health Recovery Service. Interviews were conducted with four service-users and analysed using Interpretative Phenomenological Analysis in order to examine the ideographic meaning-making participants attributed to their own lived experiences. Participants described experiences of risk assessment, but struggled to define it because it was so embedded in the day-to-day mental health care that it was difficult to separate risk assessment from other aspects of care. Complex interactions were seen to exist between risk assessment and the therapeutic relationship, with positive or negative events in one impacting the other. Issues of trust, power and the language of risk assessment were also raised. This provides an insight into how risk assessment and the therapeutic alliance are understood by service-users. Clinical implications include considerations of the use of the language of risk assessment and issues of trust and power in the therapeutic relationship.