Whilst many such incidents represent ‘near misses’, an event where potential harm was averted, or result in limited harm only, patient safety incidents remain a leading cause of death and disability worldwide.
The patient safety movement has seldom focused on research in mental health contexts. This is especially concerning, as a mental health trust was the first service to be prosecuted for providing unsafe care under legislation introduced following the Francis Report. Relative to the general population, mental health service users suffer greater problems in both mental and physical health domains. For instance, increased suicide risk, cardiovascular illnesses, and metabolic side-effects of psychotropic medications are amongst the factors which contribute to overall excess mortality for this group.
Moreover, characteristics of mental illnesses and the structure of mental health services may increase risks of preventable harm during the care process. For example, patient disengagement from preventative care interventions, difficulties with communicating with different parts of the organisation, and non-disclosure of unsafe behaviours may collectively heighten a vulnerability to receiving unsafe care, by impairing clinicians’ abilities to assess and manage risk.
The overarching aim of this doctoral research project is to study the nature of the safety problems experienced by users of community-based mental health services, identify potential areas for intervention, and conduct a small-scale implementation evaluation of an identified intervention.
There will be three stages to the research:
The project will engage directly with mental health service users groups within South London and Maudsley Mental Health Trust. Service user group involvement will inform the interpretation of the findings of the evidence review, the prioritisation of safety problems to focus on and the selection and pilot evaluation of a suitable and feasible intervention.
By identifying and mapping evidence on the nature of the safety problems this population experience, their prevalence, and evaluated interventions to improve safety, this research will produce important new insights. As well as, comparing these findings with analyses of safety incidents reported to the UK’s healthcare incident reporting database, along with interview data from service users, carers, and providers, to form original contributions to the evidence base. Importantly, this research will provide and synthesise preliminary insights within this field, identifying overlap and disparities between existing evidence, formally reported safety incidents, and stakeholder perspectives. Lastly, this pilot study will offer new evidence and direction regarding what might be potentially achieved in this setting with a subsequent larger, interventional study.
The study is funded by The Health Foundation via The Healthcare Improvement Studies Institute (THIS). It was adopted by ARC South London in September 2020 and will be completed by September 2022.
