Involving Patients and Families in the Analysis of Suicides, Suicide Attempts, and Other Sentinel Events in Mental Healthcare: A Qualitative Study in The Netherlands

Abstract

Involving patients and families in mental healthcare is becoming more commonplace, but little is known about how they are involved in the aftermath of serious adverse events related to quality of care (sentinel events, including suicides). This study explores the role patients and families have in formal processes after sentinel events in Dutch mental healthcare. We analyzed the existing policies of 15 healthcare organizations and spoke with 35 stakeholders including patients, families, their counselors, the national regulator, and professionals. Respondents argue that involving patients and families is valuable to help deal with the event emotionally, provide additional information, and prevent escalation. Results indicate that involving patients and families is only described in sentinel event policies to a limited extent. In practice, involvement consists mostly of providing aftercare and sharing information about the event by providers. Complexities such as privacy concerns and involuntary admissions are said to hinder involvement. Respondents also emphasize that involvement should not be obligatory and stress the need for patients and families to be involved throughout the process of treatment. There is no one-size-fits-all strategy for involving patients and families after sentinel events. The first step seems to be early involvement during treatment process itself.

What methods are used to promote patient and family involvement in healthcare regulation? A case study across four countries

“…The CQC additionally took advantage of a data sharing partnership with other websites collecting intelligence from users that is then used by the regulator. First, the primary espoused reason for involvement is improving regulatory work, and by consequence improving the quality and safety of care (5,16,17,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38). In this view, patients and families are seen as an additional information source.…”

“…Here their involvement is a way of regaining trust and restoring the therapeutic relationship, including the opportunity to apologize (13,14,23,39). Moreover, involvement allows for the provision of information to the patient and family, as well as space to share emotions and provide aftercare (13,14,16,23,24,31,39,50,51). Also, some reports mentioned that through involvement escalation of issues to legal claims could be avoided (16,31).…”

“…Moreover, involvement allows for the provision of information to the patient and family, as well as space to share emotions and provide aftercare (13,14,16,23,24,31,39,50,51). Also, some reports mentioned that through involvement escalation of issues to legal claims could be avoided (16,31).…”

“…Along with the possible benefits reported above, the results also show a number of difficulties experienced by regulators when putting involvement into practice. First, it can prove difficult to incorporate the input of patients and families into the decisions or reports of the regulator (6,15,16,23,31,39). This has partly to do with the perceived lack of legitimacy of patient or family input.…”

“…It is regularly argued that patients lack the necessary knowledge to contribute, and less weight is given to their input than, for instance, the input of professionals (e.g. in case of incident investigations, theme based inspections or experts-by-experience) (6,12,13,14,16,23,26,42,39). As described earlier, the main argument for involvement is that patients and families provide additional information.…”