Risk and Self Management

Written by: Michelle Howieson, Bipolar Scotland

Published: 07/03/2017

Michelle Howieson

Following the 'IRISS on… Risk' report, we contacted members of the Self Management Network Scotland to share their thoughts...

Following the IRISS on… Risk report published on 26th January 2017, we contacted members of the Self Management Network Scotland to find out their thoughts on the issue of risk in self management.

At the end of their report, IRISS asked readers to consider the following questions:

Is there space within your professional role to incorporate your personal approach to risk?
If not, are there opportunities to explore this further?
If you were to use an emotional approach to sharing risk, how could this benefit or detract from your professional practice?
How could it benefit or detract from your relationships with the people you support?

Michelle Howieson, Director at Bipolar Scotland, shared with us her thoughts on risk and self management. Michelle has written from the perspective of her own experience, both personal and professional.

Supported Positive Risk

It is important to take supported positive risk to move forward. Relationships are vital to this process being successful. The onus is on the professional to make sure the person using services feels supported and listened to. Both parties must work in partnership, listen to each other and trust each other. Working in an honest, real and person-centred way, service providers must realise that people living with long term conditions are experts by experience. Feeling like they are in the driving seat can help people to feel prepared to take positive risk with support.

If people are not allowed to take positive risks supported by their service provider they will find it difficult to move forward, requiring support from services for a longer period. Moving on is an important part of recovery and ensures service are available for other users.

Trust and Honesty

Often, it can seem like services focus on what a person is unable to do rather than what they can do. It can be life changing for someone to switch their view on this. Trusting and honest relationships between people using and delivering services can open conversations about ability and when to make changes.

The requirement for trusting and honest relationships extends to carers, including partners, family and friends. They need to know what the person wants to achieve and how they plan to do that. It is also important that they trust the expert from experience and recognise when someone living with a long term condition knows what is best for them. Listening to the person and allowing them to take back personal responsibility at their own pace and defined by them can be difficult for everyone.

My Experience of Risk

Decision Making

When making the decision to have a double transplant, it seemed my family only considered the risks and the longer recovery time. However, from my view, these risks were offset by the additional benefit in the long run. I wanted my family to support my decision. This made a big difference to my ability to make this decision and to being able to carefully weigh up the benefits and the risk involved.

After my transplant operation, I was helped by my family, friends and neighbours. There were times when it felt like they were wrapping me in cotton wool and not letting me take back responsibilities when I felt ready. This made it very difficult to move forward.

Hospital Stays

It can become even more complex with service providers as they have a responsibility to keep people safe, especially when extremely unwell and in hospital. For example, as an inpatient following a manic episode, there is a fine balance between letting people go home too soon and keeping them in hospital for too long. Discharging someone too soon can possibly lead to re-admission. Keeping them in for too long poses the risk of relapse due to loss of healthy routine and exposure to other people in hospital affecting or hampering their recovery.

One way of balancing this risk and providing the opportunity to take positive supported risks is the Intensive Home Treatment Team in NHS Lothian. In my experience, people can recover faster in their own surroundings with appropriate support from professionals. This allows people to take back personal responsibility at their own pace with the safety net of professional support when it is needed. This has the additional benefit of freeing up space in hospital for people who are in crisis.


Reducing or changing medication requires trust from professionals. With a trusting relationship, the person can do this at their own pace in a supported way. By trusting a person to be the expert on recognising how medication affects them, they can be supported to make the best decision to balance their quality of life. It can be difficult to do things to keep you well when over-medicated or not on the therapeutic dose. Getting the right balance can help people to move on in their recovery journey and to work on things to improve their physical health.

Allowing people to take extra medication if required can improve quality of life, however, it is vital to provide care and support with this. Ensuring the person is responsible by identifying and monitoring early warning signs of relapse and monitoring mood charts daily. Supporting people to access self management tools such as talking therapies, support groups and WRAP can help people to take back more responsibility. This can lead to increased confidence and self-worth.

The Risks of Risk

Choosing to take a risk must always be for the right reasons. There are some instances when it is not appropriate to encourage people using services to take a risk. Including when services are thin on the ground and appropriate support cannot be provided.

The wrong type of support, insufficient support, lack of resources or lack of after care can all lead to things becoming worse for the person and risks proving to be dangerous. Communication between all parties is key to success. Everyone must take appropriate responsibility for their part on working towards recovery. Agreeing a timescale and identifying a plan of action for identifying relapse at an early stage can all contribute to ensuring risk-taking has a positive outcome.

The Benefits of Risk

People can move forward on their recovery journey
People can access services less frequently when they have more responsibility for their own care
Increase in self-worth and self-confidence
Feel empowered and have more knowledge of their own condition and how to manage it
Improvement in mental and physical health

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