Developing risk awareness

22 June, 2020

I’m very partial to 1970’s kitchenware, and the charity shops in my neighbourhood are too often my Aladdin’s cave. A few years ago, in one of these lovely charity shops, I acquired a 1970’s apple shaped glass apple bowl. Now each to their own, but to me, this fruit bowl was top of the pops. I loved it.

The other day, whilst again disregarding our ‘don’t jump on the furniture’ rule, my son nudged the apple bowl, and yes, you’ve guessed it, down it fell with a sickening crack to meet its end on our floor. He teared up instantly, knowing that I love such sentimental items from my childhood. ‘Don’t worry’ I said in earnest giving him a cuddle, ‘accidents happen to all of us. Yes, I like the bowl, but it’s more important that you are ok. Stay away now a minute whilst I vac up the bits of glass. We don’t want your feet to be cut.’ And I very nearly meant it too!

In a situation like this, there is a risk; glass on the floor near little bare feet. It’s the right thing to do to stop everything and privilege making it safe again. This is a simple risk situation. Let’s call it a ‘Type A’ risk situation. But there are also ‘Type B’ risk situations, which have a different nature; they are complex. In Type B risk situations, there are multiple variables at play, and just simply making the protective, risk averse response always has some unintended negative consequences. We might call it ‘the risks of the risk-averse response’.

Take our work with children at MyST. Young people are distressed, and haven’t yet got healthy coping skills and supportive relationship networks. So, distressed and without healthy coping strategies nor trusted relationships, these children do their best to manage; often using risky behaviours such as harming themselves, being aggressive towards others, self-medicating with substances, and fleeing into unsafe but comforting and distracting relationships with people who would harm them. So often, adults respond by simply trying to protect the child. It’s a natural instinct of course. Who would argue with it?

But there’s a problem, Type B risk situations are not amenable to simple risk averse responses. When you tell a child they mustn’t harm themselves again when they are distressed, where can they go next? When you remove a child from school and social contact because they have been aggressive, what else is lost, and what do these losses do the child? When you tell a child you won’t have them back home if they ever misuse substances again, and because they don’t yet have another way of coping, they do it again, what then? When you lock a child up to stop them running away with unsafe people what happens when you eventually unlock the door?

When we have a complex, multi-layered Type B risk situation, we must use a more nuanced approach of balancing safeguarding a child with also giving them opportunities to develop the skills required to cease their risky behaviour in the longer term. If we only prevent anything risky occurring, we solve today’s problem whilst creating tomorrow’s problem. Taking measured risks, with the necessary support, is a fundamental process of ordinary human development. By following only the risk averse path, we ‘throw the baby out with the bathwater’ and deny children vital opportunities to grow. Opportunities to grow out of their risky problem altogether.

What we at MyST commonly see in children’s mental health care is children escalating up the tiers of services, to more and more ‘specialist’ and restrictive care settings as the failure of Type A responses to Type B problems is repeated. Children ‘get worse’ as they are restricted, dismissed and excluded in response to their original risky coping behaviours. At MyST, our core raison d’etre is to challenge this process, to bring children back from specialist institutions into family and community environments, and to de-escalate risks by giving children measured opportunities to build alternative ways of managing their distress with the close guidance of key adults alongside them 24/7.

It is vitally important to see the error of applying simple risk averse responses to complex risk situations. Not doing so has the most serious personal and societal costs.

Jen & Jael

A Gwent Partnership Board Service