Dignity of risk is a term used to describe the right of individuals to choose to take some risk in engaging in life experiences. Craig Parsons says it is important that people with mental illnesses are not overprotected.
The dignity of risk, or the right to failure, is a value first championed by advocates for people with physical disabilities.
The dignity of risk, or the right to failure, is a value first championed by advocates for people with physical disabilities. It's an important concept for people living with a mental illness and one that mental health service providers should be mindful of.
Following diagnosis with a mental illness many people feel subject to a double standard in attitudes towards their ability for self-determination. In the process of receiving treatment they seem to have somehow given up their "right" to make risky or potentially self-defeating choices without intervention from authorities, clinicians, service providers or even family members wishing to protect them.
Every endeavour has an element of risk, and every opportunity for growth carries with it the potential for failure. All people learn through a process of trial and error; often learning as much from their mistakes as from their successes.
When people living with a mental illness are denied the dignity of risk, they are being denied the opportunity to learn and recover.
The dignity of risk is an important concept. It places an emphasis on personal choice and self determination - two concepts that are central to recovery.
Anthony (2000) states: "the notion that one has options from which to choose is often more important than the particular option one initially selects.
Pat Deegan (1996): Self-determination, or taking responsibility for one's own recovery, is the core component of recovery. Part of that responsibility involves the self-management of wellness and medication, autonomy in one's life choices and the willingness to take informed and planned risks in order to grow.
Given that the dignity of risk can be understood as a human rights issue and that its presence is closely associated with recovery, what keeps us from encouraging people to make choices? What stops us from allowing people living with a mental illness the dignity of risk?
One of the biggest barriers is fear: of the unknown, of the legal ramifications, of failure. Mental health service providers worry that if a consumer takes a risk and fails that it implies they are doing a bad job. We need to encourage staff to see the positives in risk, the positives that can come out of failure and allow consumers to internalise the locus of control for their choices and actions. Failure, far from being a dirty word, can be used as a learning opportunity. Supporting people through failure can assist them to develop resilience.
Systems are another barrier to the dignity of risk. Methods of operating should be reviewed to determine whether they service the organisation's goals as opposed to the consumers'. One of the ways to combat this is to promote consumer advocacy within organisations and to ensure that there is consumer presence on boards of management.
Time is another. In practical terms it is simply quicker and easier for decisions to be made for mental health consumers than it is for their service providers to collaborate and plan with them.
Finally, environments are a barrier to the dignity of risk. When consumers are in institutions, hospitals or group homes, often their capacity for choice is severely limited. Choices as simple as when to get up, what you're going to eat or who you are going to spend your time with are taken away. We need to ensure that appropriate accommodation and support exists in the community so that people living with a mental illness can exercise their right to make choices, take risks, participate in and potentially thrive in the sometimes scary and unknown outside world.
Hope is central to recovery. Every choice involves both the possibility of failure or success. Over-protectiveness, taking away people's choices, not allowing them to take risks or try new things crushes hope. This can be seen in many people who have been institutionalised or hospitalised for any great length of time. It can also lead to learned helplessness, which is often more debilitating and disabling than any illness itself (Petersen, Maier & Seligman, 1995). By supporting dignity of risk and encouraging people to make choices and take chances, service providers help to combat learned helplessness and bolster self-esteem, self-respect, empowerment, hope and support recovery.
This blog is adapted from a presentation I made as a representive of Neami at TheMHS Conference 2008. Neami is a national psychosocial health and rehabilitation support provider, who works with and on behalf of people living with a mental illness. Neami works to identify service gaps in the community, develop new services and to achieve community acceptance, protection and expression of the rights of people with psychiatric disabilities in the community. For more information please visit www.neami.org.au
List of References:
Perske, R. (1973). Hope for the families - New directions for parents of persons with retardation or other disabilities. Nashville. Abingdon Press. p 51.
Anthony, W. (2000). A Recovery oriented service system: Setting some system level standards. Psychiatric Rehabilitation Journal, 24(2), 159-168.
Deegan, P. (1996) Recovery as a journey of the heart. Psychiatric Rehabilitation Journal, 11, 11-19.
Petersen, C., Maier, S.F., Seligman, M.E.P. (1995). Learned Helplessness: A Theory for the Age of Personal Control. New York: Oxford University Press. p 241-242.
Advocates Inc & Deegan, P (2001). The intentional care approach to supporting client choice, Intentional Care. http://www.intentionalcare.org/