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Background National policies and guidelines advocate that mental health practitioners employ positive risk management in clinical practice. However, there is currently a lack of clear guidance and definitions around this technique. Policy reviews can clarify complex issues by qualitatively synthesising common themes in the literature. Aims To review and thematically analyse national policy and guidelines on positive risk management to understand how it is conceptualised and defined. Method The authors completed a systematic review (PROSPERO: CRD42019122322) of grey literature databases (NICE, NHS England, UK Government) to identify policies and guidelines published between 1980 and April 2019. They analysed the results using thematic analysis. Results The authors screened 4999 documents, identifying 7 eligible policies and 19 guidelines. Qualitative synthesis resulted in three main themes: i) the conflicting aims of positive risk management; ii) conditional positive risk management; and iii) responsible positive risk management. Conclusions Analysis highlighted discrepancies and tensions in the conceptualisation of positive risk management both within and between policies. Documents described positive risk management in different and contradictory terms, making it challenging to identify what it is, when it should be employed, and by whom. Five policies offered only very limited definitions of positive risk management.

To explore inpatient staff's understanding and implementation of positive risk management.Risk management is an essential skill for staff working in acute mental health inpatient settings. National policies advocate the use of positive risk management as a form of collaborative, recovery-focused risk management. However, little is known about how staff understand, operationalize, and use positive risk management in practice.Qualitative reflexive thematic analysis study.The authors recruited a purposive sample of healthcare professionals working in acute inpatient settings (N = 16) in 2019 across three National Health Service Trusts in the North-West of England. Participants completed semi-structured interviews which were analysed using reflexive thematic analysis.The analysis generated three themes: (a) within staff barriers; (b) within service user barriers; and (c) delivery in practice.Understanding and implementation of positive risk management was dependant on multiple factors, including staffs' beliefs about mental health, levels of worry and anxiety, and amount of experience and seniority. Staff were more likely to use positive risk management with service users that they perceived as being trustworthy and less risky. Use of positive risk management was reliant on the support practitioners received, how able they were to view situations from multiple perspectives, and the degree to which they felt able to prioritize positive risk management.Although staff expressed the desire and intention to practice positive risk management, the current study highlights challenges around operationalization and implementation. The authors discuss the clinical implications of the findings.目的: 探讨住院部职工对积极风险管理的理解和实施情况。 背景: 对于在急性精神健康住院病房中工作的职工而言, 风险管理是一项基本技能。国家政策建议, 应协作执行积极的风险管理, 以恢复为重点。然而, 职工在实践中如何理解、实施和使用积极的风险管理尚未完全明确。 设计: 定性及自反性主题分析研究。 方法: 2019年, 本文作者有目的的在英格兰西北部的三个国家医疗服务信托机构中招募急性住院病房医疗专业人员 (N = 16) 。参与者均接受半结构化访谈, 且已通过自反性主题分析对访谈内容进行分析说明。 结果: 分析过程中, 产生三个主题: (a) 职工障碍; (b) 服务接受者障碍; (c) 实际的实行情况。 结论: 积极风险管理的理解和实施取决于多个因素, 包括职工的心理健康观念、担忧和焦虑程度、经验和资历等。职工更倾向于对其认为值得信赖且风险较小的服务接受者实施积极的风险管理。积极风险管理的应用取决于实践者所获支持, 多维判断能力及其认为应优先考虑积极风险管理的程度。 影响: 尽管职工有意实行积极的风险管理, 但当前研究表明, 此类风险管理的操作和实施仍面临挑战。本文作者对此发现的临床意义进行探讨。.