Risk assessment in mental health has long been one of the most sensitive and complex aspects of care. At its best, it helps ensure safety and guide meaningful support. At its worst, it becomes a tick-box exercise—overly focused on covering professionals’ backs rather than truly helping the people it’s meant to serve.
For over 15 years, the main national guidance on this topic — Best Practice in Managing Risk — has remained unchanged. Since its release in 2007, our understanding of trauma, mental health, and human rights has progressed significantly. Yet, the system seems stuck. Too often, people experiencing distress are seen through a lens of danger and deficit, rather than context, capacity for change, or support needs. This can lead to harmful practices, from unnecessary hospital admissions to neglect in the community.
We’ve seen the tragic consequences when risk isn’t properly understood or managed. The deaths of individuals like Steven Hoskin, Connor Sparrowhawk, and Sophie Bennett — each preventable — highlight how fragmented systems, defensive practice, and a failure to see the whole person can have devastating outcomes. And despite inquiry after inquiry, we’re not learning fast enough.
One of the biggest problems is that risk assessments are often driven by fear — of being blamed, of media headlines, of legal repercussions. This “defensive practice” culture can distort priorities. Professionals may act to protect their organisations rather than building trust, listening, and working collaboratively with the person in distress. Risk becomes something to be managed about the person, rather than with them.
What’s missing is a trauma-informed, person-centred approach. That means recognising that many people in mental health services have experienced significant adversity. It means understanding that language matters — that calling someone “non-compliant” or “a high risk of harm” without context can retraumatise and stigmatise. And it means focusing not just on what could go wrong, but also on what can go right: people’s strengths, aspirations, and networks of support.
A better approach would start by asking different questions: What’s happened to this person? What helps them feel safe? What are their goals, and how can we support them while managing concerns about safety? Collaborative safety planning, advance directives, and strengths-based conversations can replace forms that feel like surveillance tools.
Of course, we can’t ignore that the system is under strain. Staff are overworked and under-resourced. Many receive little training on how to have these nuanced, relational conversations about risk. But this is precisely why the national framework must be updated — to set a new tone and direction, and to shift the culture away from fear and blame.
Ultimately, this is about restoring humanity to mental health care. Risk will always be part of life, especially in services that support people in crisis. But we must be honest: our current approach can do harm. It can alienate people. It can strip away autonomy. It can stop us from listening. And it can prevent the very relationships that make healing possible.
We need to move towards a more thoughtful, compassionate model — one that understands risk in its social, psychological, and emotional context, not just through statistics or history. One that empowers professionals to take thoughtful, proportionate risks in partnership with service users. And one that recognises that safety is not just about preventing harm—it’s about building trust, dignity, and hope.