This essay discusses a shift in the priorities in the psychiatric community over the past several decades from one that focuses upon the relief of suffering toward one that emphasizes harm reduction and danger prevention. The essay reviews the various forces that have driven this evolution including legal decisions that have limited grounds for admission to dangerousness, models of care that emphasize “zero suicide,” a rise in liability for outpatient suicide and the resulting practice of defensive medicine. The essay also notes the role that the overselling of psychiatry’s ability to prevent negative outcomes has played in shaping these developments. The essay then argues that while preventing self-harm and violence are certainly important goals, the overall refocuses of psychiatric practice to prioritize these aims has had a deleterious effect upon patient care and should be reversed. The essay advocates for a different approach to mental health care and will enable to psychiatric profession to return to its helping origins.

Harm prevention, Defensive medicine, Positive psychiatry, Helping, Healing