Trust as a Means of Bridging the Management of Risk and the Meeting of Need: A Case Study in Mental Health Service Provision

Shifts in public policy towards an increasing focus on risk have been deemed problematic at a number of levels, particularly the tendency for concerns over reputational risk to institutions to trump the interests and needs of service-users. This article explores the tension between these two dimensions, of risk and need, in a case study of local mental health services - a setting where conflicting objectives to manage risk and meet need are apparent. Media-driven pressure to ward against the 'risk' represented by service-users tends towards more coercive policy which may obstruct the meeting of need, which in turn may undermine service-user engagement and hinder risk management. Drawing on qualitative data from interviews with service-users, professionals and managers, the article explores the process of trust and its facilitative role in meeting need and managing risk. Findings suggest that while existing foci on risk are at times counter-productive, trust plays a significant role in service-users' initial and ongoing engagement, communication and co-operation with professionals. Yet inherent obstacles to trust within mental healthcare contexts remain, due to cultural pressures on professionals, the nature of the illness experience and negative past experiences of in-patient care. © 2012 Blackwell Publishing Ltd.