27. May 2026

Reflections from the Classroom: On "Engagement", Safety and the Stories We Tell Ourselves

A few weeks ago I was invited to speak with a group of AMHPs in Manchester about conversations around suicide and self-harm within Mental Health Act assessments.

As usual, the most useful part came out of discussions. The discussion moved quickly away from legislation and process and into the uncomfortable, complicated reality of practice.

One question stayed with me:

*How do we work collaboratively with people who have a history of poor engagement with services?*

It is such a common phrase in mental health practice that it almost disappears into the background. Poor engagement. Difficult to engage. Historically non-engaging. We hear it in handovers, referrals, MDT discussions and risk formulations. Sometimes it becomes so embedded in the narrative around a person that it starts to function almost as a fixed characteristic rather than a description of a relationship between somebody and a system.

The more I thought about it, the more I found myself sitting with the word itself.

Engagement is odd language when you stop and examine it. Outside health and social care it often belongs to the language of conflict. Armies engage. Opposing forces engage. There is something adversarial hiding within the term; an implication that one side is trying to draw the other into something.

I wonder whether, without intending to, we sometimes recreate that dynamic in mental health services.

Very often when we describe somebody as not engaging, what we actually mean is that they are not interacting with services in the way services would like them to. They are missing appointments, declining support, not disclosing openly, not trusting quickly enough, or not responding in ways that reassure professionals.

In suicide and self-harm work especially, we have to be careful about the assumptions we make here.

NICE NG225 repeatedly emphasises relational safety, collaboration, compassion and understanding the meaning behind self-harm within the context of somebody's life. The guidance speaks clearly about avoiding punitive responses and recognising how previous experiences with services shape future help-seeking. That matters because many people described as non-engaging have often learned something very important from previous contact with services.

For some, disclosure has led to coercive responses or a loss of control. Others have experienced assessments that felt exposing without ever feeling containing. Sometimes people come away with the sense that systems are more interested in categorising distress than making sense of it with them.

None of this means professionals are uncaring. Most AMHPs are trying to do thoughtful work under enormous pressure, within systems that are increasingly defensive and stretched.

But systems communicate things to people, whether intentionally or not.

The phrase "failure to engage" subtly places responsibility on the person at the edge of the system whilst leaving the system itself relatively unscrutinised. Yet people rarely fail to collaborate for no reason. More often, systems fail to create enough safety for collaboration to feel possible.

That is particularly important within MHA work because the assessment interview is not a neutral relational space. However compassionate the interviewer may be, statutory power is present in the room from the outset. People know decisions may be made about detention, liberty and control.

There is writing from practitioners working with dialogical and solution-focused approaches within AMHP practice that I keep returning to. What I find valuable in those discussions is the insistence that assessment is not simply information gathering. The interview itself is an intervention. The quality of the interaction matters.

A dialogical stance changes the emotional atmosphere. Rather than viewing ambivalence, guardedness or distrust as obstacles to overcome, they become understandable responses worthy of curiosity. Even small linguistic shifts matter. Asking somebody what has made it difficult to trust services often opens a very different conversation than asking why they do not engage.

This feels particularly relevant in suicide and self-harm assessments because people are making rapid judgements about emotional safety long before any formal risk questions are asked. They may be wondering whether they will be judged, whether honesty will make things worse, whether the person in front of them is trying to understand them or simply manage risk. Those questions are rarely articulated directly, but they are often present underneath the interaction.

Sometimes what services interpret as resistance is actually self-protection.The longer I work in this area, the less convinced I become that collaboration can ever be demanded into existence. It emerges when people experience enough transparency, emotional containment and relational safety to risk being known.

That does not remove the realities of statutory work. Risk still matters. Capacity still matters. There are moments where professionals must act in ways somebody may profoundly disagree with. But even within those realities, there is a difference between exercising power thoughtfully and simply expecting compliance.

Once somebody becomes described as non-engaging, it can easily harden into identity rather than remain a reflection on a particular interaction, context or relationship. The phrase risks implying unwillingness or oppositionality when the reality may be fear, shame, hopelessness, trauma, previous iatrogenic harm, or simply exhaustion.

I wonder whether we would think differently if we wrote differently.

Instead of writing that somebody "failed to engage", we might describe that they did not experience contact with services as safe or helpful at that point in time. Rather than "non-compliant", we could acknowledge ambivalence about intervention, or distrust rooted in previous experience. Small changes in language can keep the person's experience visible within the assessment rather than reducing them to a behavioural problem to be managed.

Language shapes attitude, and attitude shapes practice.

If we begin from the assumption that withdrawal, avoidance or guardedness may be meaningful rather than obstructive, we are more likely to remain curious, relational and humane in our assessments. And in suicide and self-harm work especially, that curiosity may matter more than we realise.