Risk Redux? Therapeutic Risk Taking and the Role of Supported Decision Making in Mental Health Settings

Abstract

The prevailing culture of risk aversion and defensive practice within mental health systems significantly undermines recovery and well-being. In response, many Western jurisdictions are undergoing a fundamental transformation of mental health legislation, shifting towards a human rights-based approach. This transition emphasises supported decision-making, a reduction in coercive practices, and a stronger focus on recovery-oriented care. As services shift towards being human rights-led, clinicians need to move from making decisions for individuals in their best interests to considering what support is required to enable people to make their own choices; a difficult shift within services that remain risk-averse within a substitute decision-making regime. This paper reconceptualises risk not solely as a threat to be managed, but as a potential catalyst for recovery and empowerment. The authors call for a movement away from defensive, risk-averse models towards defensible and considered practices that thoughtfully balance safety with individual autonomy. At the heart of this shift is the innovative Dimensions of Safety framework, which assists practitioners in navigating complex decision-making processes while aligning their approaches with both human rights principles and the person's right to self-determination. This framework encourages therapeutic risk-taking as a means of fostering personal growth, resilience and empowerment. Furthermore, it incorporates cultural and spiritual dimensions to ensure care is equitable and inclusive. A trauma-informed perspective is also central, recognising the impact of past adversity on current mental health and decision-making skills. By challenging the dominance of substituted decision-making and promoting collaborative, rights-based care, this framework offers a practical and ethical pathway towards mental health systems that are safer, more inclusive and genuinely supportive of recovery and autonomy.