Patient safety and quality of care in mental health: a world of its own?

D’Lima, Danielle; Crawford, Mike; Darzi, Ara; Archer, Stephanie

doi:10.1192/pb.bp.116.055327

Cited by 31 publications

(33 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Good practice outlined in the remaining themes broadly applies to all healthcare settings, e.g., ‘developing strong relationships with patients and carers’, and ‘providing timely access to tailored and appropriate care ’ . However, there are important contextual differences in providing safe, high quality care in mental healthcare services, where the majority of patient safety incidents relate to self-harm, aggressive behaviours, restraint, absconding and reduced capacity for self-advocacy [18, 19]. Thus, the consequences of failing to provide good practice in mental healthcare service settings can have serious implications for patients.…”

Section: Discussionmentioning

confidence: 99%

Learning from clinicians’ views of good quality practice in mental healthcare services in the context of suicide prevention: a qualitative study

et al. 2019

View full text Add to dashboard Cite

BackgroundSuicide and non-fatal self-harm represent key patient safety events in mental healthcare services. However, additional important learning can also be derived by highlighting examples of optimal practice that help to keep patients safe. In this study, we aimed to explore clinicians’ views of what constitutes good practice in mental healthcare services in the context of suicide prevention.MethodsData were extracted from the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) database, a consecutive case series study of suicide by people in contact with mental healthcare services. A large national sample of clinicians’ responses was analysed with a hybrid thematic analysis.ResultsResponses (n = 2331) were submitted by clinicians across 62 mental healthcare providers. The following five themes illustrated good practice that helps to: 1) promote safer environments, 2) develop stronger relationships with patients and families, 3) provide timely access to tailored and appropriate care, 4) facilitate seamless transitions, and 5) establish a sufficiently skilled, resourced and supported staff team.ConclusionThis study highlighted clinicians’ views on key elements of good practice in mental health services. Respondents included practice specific to mental health services that focus on enhancing patient safety via prevention of self-harm and suicide. Clinicians possess important understanding of optimal practice but there are few opportunities to share such insight on a broader scale. A further challenge is to implement optimal practice into routine, daily care to improve patient safety and reduce suicide risk.

show abstract

Section: Discussionmentioning

confidence: 99%

Learning from clinicians’ views of good quality practice in mental healthcare services in the context of suicide prevention: a qualitative study

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Questions regarding the status and usefulness of psychiatric diagnosis partly explain this. Uncertainties about the effectiveness of many psychiatric interventions, wide variations in clinical practice, poor patient safety (D'Lima et al ., 2017) and lack of good quality outcome data on matters most relevant to service users (Thornicroft and Slade, 2014) all contribute to the generally negative perceptions of psychiatry. However, the most contentious aspect of contemporary psychiatry is its continuing reliance on coercion as part of clinical care, a legacy of its institutional history.…”

Section: Introductionmentioning

confidence: 99%

Reducing coercion in mental healthcare

Sashidharan

Mezzina

Pūras

2019

Epidemiol Psychiatr Sci

121

View full text Add to dashboard Cite

AimsTo examine the extent and nature of coercive practices in mental healthcare and to consider the ethical, human rights challenges facing the current clinical practices in this area. We consider the epidemiology of coercion in mental health and appraise the efficacy of attempts to reduce coercion and make specific recommendations for making mental healthcare less coercive and more consensual.MethodsWe identified references through searches of MEDLINE, EMBASE, PsycINFO and CINAHL Plus. Search was limited to articles published from January 1980 to May 2018. Searches were carried out using the terms mental health (admission or detain* or detention or coercion) and treatment (forcible or involuntary or seclusion or restraint). Articles published during this period were further identified through searches in the authors' personal files and Google Scholar. Articles resulting from searches and relevant references cited in those articles were reviewed. Articles and reviews of non-psychiatric population, children under 16 years, and those pertaining exclusively to people with dementia were excluded.ResultsCoercion in its various guises is embedded in mental healthcare. There is very little research in this area and the absence of systematic and routinely collected data is a major barrier to research as well as understanding the nature of coercion and attempts to address this problem. Examples of good practice in this area are limited and there is hardly any evidence pertaining to the generalisability or sustainability of individual programmes. Based on the review, we make specific recommendations to reduce coercive care. Our contention is that this will require more than legislative tinkering and will necessitate a fundamental change in the culture of psychiatry. In particular, we must ensure that clinical practice never compromises people's human rights. It is ethically, clinically and legally necessary to address the problem of coercion and make mental healthcare more consensual.ConclusionAll forms of coercive practices are inconsistent with human rights-based mental healthcare. This is global challenge that requires urgent action.

show abstract

“…Many features in guidelines and programs to manage violence are in line with the recovery approach such as involving patients in all decisions about their care and treatment and improving their experience of staying in the ward [19] forming supportive relationships, giving hope, meaningful activities and developing coping skills [13, 20]. This implies that work with safety and quality of care needs to be integrated in order to be beneficial to patients in mental health care [21]. In studies of patient views on psychiatric inpatient wards, patients have reported that they appreciate staff who communicate and create a therapeutic relationship with them.…”

Section: Introductionmentioning

confidence: 99%

Feeling safe or unsafe in psychiatric inpatient care, a hospital-based qualitative interview study with inpatients in Sweden

Pelto‐Piri

Wallsten

Hylén

et al. 2019

Int J Ment Health Syst

View full text Add to dashboard Cite

Background A major challenge in psychiatric inpatient care is to create an environment that promotes patient recovery, patient safety and good working environment for staff. Since guidelines and programs addressing this issue stress the importance of primary prevention in creating safe environments, more insight is needed regarding patient perceptions of feeling safe. The aim of this study is to enhance our understanding of feelings of being safe or unsafe in psychiatric inpatient care. Methods In this qualitative study, interviews with open-ended questions were conducted with 17 adult patients, five women and 12 men, from four settings: one general psychiatric, one psychiatric addiction and two forensic psychiatric clinics. The main question in the interview guide concerned patients’ feelings of being safe or unsafe. Thematic content analysis with an inductive approach was used to generate codes and, thereafter, themes and subthemes. Results The main results can be summarized in three themes: (1) Predictable and supportive services are necessary for feeling safe. This concerns the ability of psychiatric and social services to meet the needs of patients. Descriptions of delayed care and unpredictable processes were common. The structured environment was mostly perceived as positive. (2) Communication and taking responsibility enhance safety. This is about daily life in the ward, which was often perceived as being socially poor and boring with non-communicative staff. Participants emphasized that patients have to take responsibility for their actions and for co-patients. (3) Powerlessness and unpleasant encounters undermine safety. This addresses the participants’ way of doing risk analyses and handling unpleasant or aggressive patients or staff members. The usual way to act in risk situations was to keep away. Conclusions Our results indicate that creating reliable treatment and care processes, a stimulating social climate in wards, and better staff-patient communication could enhance patient perceptions of feeling safe. It seems to be important that staff provide patients with general information about the safety situation at the ward, without violating individual patients right to confidentiality, and to have an ongoing process that aims to create organizational values promoting safe environments for patients and staff. Electronic supplementary material The online version of this article (10.1186/s13033-019-0282-y) contains supplementary material, which is available to authorized users.

show abstract

Patient safety and quality of care in mental health: a world of its own?

Cited by 31 publications

References 20 publications

Learning from clinicians’ views of good quality practice in mental healthcare services in the context of suicide prevention: a qualitative study

Learning from clinicians’ views of good quality practice in mental healthcare services in the context of suicide prevention: a qualitative study

Reducing coercion in mental healthcare

Feeling safe or unsafe in psychiatric inpatient care, a hospital-based qualitative interview study with inpatients in Sweden

Contact Info

Product

Resources

About