Abstract

Case study: while on placement at a mental health day centre I was assigned to act as key-worker to Mr X, a working-class white man in his early 40s who has been diagnosed with several psychiatric disorders. Mr X also experiences poor physical health. Mr X has been diagnosed as ?having? obsessive compulsive disorder, major depressive disorder, anger management disorder, Tourette's syndrome and paranoia. He has also been diagnosed with fibromyalgia. For all these, he daily takes a powerful cocktail of anti-depressants, mood-stabilizers, anti-psychotics and pain killers. From his file I noted that he had been discharged from the local community psychiatric team, so he no longer had regular and unproblematic access to either a psychiatrist or social worker. He had been receiving anger management therapy (AMT), but his attendance had been sporadic. Mr X had, he claimed, no real friends, or, as he put it, ?just mere acquaintances?. Mr X lives alone with his mother. Mr X was a new member at the day centre but had had a long career as a mental health service user (owing to his angry behaviours he had been ?asked to leave? his previous day centre). The stated and overt purpose of our relationship was to collaborate towards ameliorating his situation. This work more commonly consisted of offering emotional and practical support, but, when first assigned Mr X, I was told by my practice assessor that eventually I would be required to carry out a risk assessment of him. So, for the purposes of this essay, I will focus on the ethical problems and dilemmas I encountered in the progression leading towards, and the actual process of carrying out, an assessment of the supposed risk that Mr X may pose either to himself, others or both