Risk redux? : Therapeutic risk taking and the role of shared and supported decision making in mental health settings

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Hamer, Helen and Lampshire, Deborah and Thom, Katey and Sutton, Daniel and MacIntyre, Gillian and Cogan, Nicola (2026) Risk redux? : Therapeutic risk taking and the role of shared and supported decision making in mental health settings. International Journal of Mental Health Nursing. ISSN 1447-0349 (In Press)

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Abstract

The dominant culture of risk aversion and defensive practice within the mental health system in Aotearoa New Zealand has contributed to disproportionately high levels of compulsory detention and seclusion, particularly affecting the indigenous Māori population. These practices reflect systemic inequities and often undermine recovery and well-being. In response, New Zealand is undergoing a significant transformation of its mental health legislation to adopt a human rights-based approach. This shift aims to integrate supported decision-making, reduce coercion, and prioritise recovery-oriented practices. This paper reconceptualises risk, moving beyond its traditional association with danger to embrace its potential as a positive force for recovery. It advocates for a shift from defensive, risk-averse practice to defensible and considered practice that balances safety and autonomy. Central to this transformation is the innovative ‘dimensions of safety’ framework, designed to support practitioners in navigating the complexities of decision-making while aligning their practice with human rights principles and the individual’s autonomy. The framework encourages therapeutic risk-taking as a means to empower individuals, enhance resilience, and promote personal growth. It incorporates cultural and spiritual considerations, particularly within Māori health contexts, to ensure equitable and inclusive care. Additionally, it advocates for trauma-informed practices that recognise the influence of past adversities on present mental health and decision-making capacities. By reducing the dominance of substituted decision-making and promoting collaborative, rights-based care, the framework provides a practical and ethical pathway for transforming mental health practice in Aotearoa New Zealand. This approach fosters safer, more inclusive environments that actively support recovery and autonomy.

ORCID iDs

Hamer, Helen, Lampshire, Deborah, Thom, Katey, Sutton, Daniel, MacIntyre, Gillian ORCID logoORCID: https://orcid.org/0000-0003-4247-1276 and Cogan, Nicola ORCID logoORCID: https://orcid.org/0000-0003-0861-5133;
CORE (COnnecting REpositories)