How is risk discussed in crisis resolution home treatment teams? A conversation analysis

Background/Aims: Risk discussions are an essential aspect of effective assessment and management in mental health services; however, there is little research exploring how clinicians engage in risk discussions in practice. This study aimed to explore the ways in which risk is discussed in crisis resolution home treatment teams using a conversation analysis approach. Methods: Audio recordings were collected from crisis resolution home treatment multidisciplinary team meetings. Conversation analysis, a sociological qualitative method for the detailed study of naturally occurring talk-in-interaction, was used to analyse the recordings. Findings: Four key areas of risk talk were identified: presenting a risk concern, sharing information, negotiating risk, and developing a risk and/or support plan. Clinicians presented risk concerns and use hedging language when discussing risk. Clinicians, who included nurses, social workers, occupational therapists and psychiatrists, frequently self-selected information and subjective perspectives to contribute to collaborative risk practice, while also managing team cohesion. Conclusions: Risk discussions are a central feature of multidisciplinary work in crisis resolution home treatment teams, shaped by clinicians' use of tentative language, self-selection, and the collaborative negotiation of perspectives. These interactional practices appear to support shared decision making about risk while maintaining team cohesion, but also illustrate how subjectivity and accountability are distributed across team members rather than held by any individual clinician. Implications for practice: Findings highlight the value of providing mental health nurses with structured opportunities to present risk concerns within multidisciplinary team meetings, as this can facilitate the sharing of information, perspectives and clinical accountability. Awareness of how hedging and tentative language function in risk discussions may help mental health nurses to participate more confidently in collaborative risk practice and shared decision making. Training in interactional features of risk talk may further support nurses in negotiating different perspectives while maintaining therapeutic team relationships.