Conflicting roles in managing risk with service users in supported housing

Last week, while delivering training, the model below occurred to me.  It represents the two roles that a Supported Housing Worker or similar professional has in relation to managing risk with service users.

Most of the time an empowering approach works best to reduce risk. Often risk taking is an attempt by the service user to assert independence and take control, so supporting and empowering a service user may work to reduce their need to take risks. Being positive about them and their lives, allowing learning from risk taking through adult dialogue, and building a non controlling and trusting relationship will also work to reduce the service user’s desire to take risks.

However, some risks are so significant (such as an immediate risk of suicide or abuse), that the service user or other people must be protected. Failure to do so may lead to charges of negligence or worse against the worker. At this point a protection agenda kicks in, which is almost the opposite of the enabling one.

The judgement of the professional involved is required to decide which approach to take in which situation, and the border between the two is unclear. In most cases protection wins when there is doubt, as people naturally act to assert control when they fear a risk.

Client risk management – the paradox of control

When you are working with vulnerable people in a service paid for by the Local Authority Supporting People team, you have a directive paymaster who wants to see certain things for their money. Other stakeholders include the organisation you work for and the client themselves.  What the 3 want or need can be quite different.

The paradox I see is this:  when we provide support to vulnerable people, we are expected to control risk, yet by trying to control that risk we often create it or enlarge it.

Clients take risks – its a normal part of being an adult, and you may want to encourage the client to be an independent adult.  A lot of risk taking relates to wanting to feel in control – and may mean breaking rules.  The more they are under control, or feel they have lost control, the more risky behaviour may become.  For example, someone who cuts themself may be doing this to feel in control of their body.  Tell them to stop, and the risk is they will cut more.  Nag them some more, try to control them more, and they’ll withdraw from you, show their control in other ways.  Maybe all you can do is support them to explore alternatives and understand why they are cutting.

Yet the duty of care kicks in – organisations, and Local Authorities, are scared of risk, with good cause.  They would like things to be safe, predictable and controlled.  They don’t want clients to cut themselves.  You don’t either, but how can you show this without exerting the control that may make things worse?  It takes bravery to hand control to the client.

Compound this with the common psychology of those working with vulnerable people, who want to “help” – to rescue people.  This can lead to inappropriate offers of help, which can become either somethering or controlling.

Yet even if you are brave and self aware enough to step back and support the empowered client, you run risks.  Have you judged it right?  At some points you do have to step in and take control, especially if there is a risk of suicide.  Dead is dead – and stopping someone from killing themselves or others if the first of your duties.  With that in the back of your mind, how do you know if the cutting is just the tip of an iceberg you have failed to uncover.  What about all those other risk factors…..

As with most paradox, I think we can only hope to manage as best we can, bearing the weight of expectation from our 3 main stakeholders, taking our own risks.