5: Boundaries of risks and rights and personality disorder


The chapter looks at the ways in which decision makers (in this case Approved Mental Health Professionals [AMHPs]) construct and deconstruct their frameworks of understanding relating to the assessment of people who are diagnosed with personality disorders. It focuses on the assessment of service users who are subject to a high number of assessments and appear to occupy a disproportionate amount of mental health professionals’ time, both literally and emotionally.

The chapter is based on extracts from the author’s own research and explores the risk paradigm that AMHPs believe shapes the work that they do – in particular, a culture of blame. The factors that AMHPs believe prevent them from making decisions that they feel are in the best interest of the people they are assessing will be explored and contextualised.

The chapter also explores how theories of alienation – in particular, malignant alienation – can help AMHPs and other mental health professionals understand the negative relationship cycles that reinforce unhelpful coping strategies. A critical approach is taken towards the medicalisation and pathologising of what are essentially psychosocial behavioural reactions, and alternative interventions for managing what are perceived as service users’ unhelpful or self-defeating coping strategies are discussed.

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