A qualitative exploration of mental health service user and carer perspectives on safety issues in UK mental health services

Abstract

BackgroundService user and carer perspectives on safety issues in mental health services are not well known and may be important in preventing and reducing harm. The development of the Yorkshire Contributory Factors Framework—Mental Health (YCFF‐MH) provides a broad structure within which to explore these perspectives.ObjectiveTo explore what service users of mental health services and their carers consider to be safety issues.Design, setting and participantsQualitative interviews with 13 service users and 7 carers in the UK. Participants were asked about their experiences and perceptions of safety within mental health services. Perceived safety issues were identified using framework analysis, guided by the YCFF‐MH.ResultsService users and carers identified a broad range of safety issues. These were categorized under ‘safety culture’ and included psychological concepts of safety and raising concerns; ‘social environment’ involved threatened violence and sexual abuse; ‘individual service user and staff factors’ dominated by not being listened to; ‘management of staff and staffing levels’ resulting in poor continuity of care; and ‘service process’ typified by difficulty accessing services during a crisis. Several examples of ‘active failures’ were also described.Discussion and conclusionsSafety issues appear broader than those recorded and reported by health services and inspectorates. Many safety issues have also been identified in other care settings supporting the notion that there are overlaps between service users and carers’ perspectives of safety in mental health services and those of users in other settings. Areas for further research are suggested.

Health professionals’ perspectives of safety issues in mental health services: A qualitative study

“…They described the approach to safety in the community as focused less on the medical model. This reflects previous findings on patient's perceptions of safety in the community (Berzins et al 2020). Although, Coffey et al (2017) found that risk assessment and care planning in the community is conservative, and patients are often not involved.…”

“…This reflects previous findings on patient’s perceptions of safety in the community (Berzins et al . 2020). Although, Coffey et al .…”

“…Due to the diversity of experiences and richness of data, interviews with patients and carers are reported elsewhere (Berzins et al . 2020). Recruitment via social media enabled the inclusion of professionals with varied experiences working across mental health services and organizations.…”

“…In a previous, linked study mental health professionals, patients and carers completed an exploratory survey (recruited via Twitter) about the safety of mental health services and indicated as part of the survey if they would like to be contacted to take part in an interview (Berzins et al 2018). Due to the diversity of experiences and richness of data, interviews with patients and carers are reported elsewhere (Berzins et al 2020). Recruitment via social media enabled the inclusion of professionals with varied experiences working across mental health services and organizations.…”

“…In the UK, in 2017 the Care Quality Commission considered over a third of mental health services inadequate in terms of safety (Care Quality Commission 2018). Yet the perception of safety issues from perspectives of patients, carers and health professionals remains under researched (Berzins et al 2018;Berzins et al 2020;Thibaut et al 2019).…”