Service user and carer involvement in the safety of mental health services


CLAHRC Yorkshire and Humber (Evidence Based Transformation with the NHS)

Why is this project important?

While there has been a significant research focus on patient safety within acute hospital and primary care settings, there has been much less research into the identification of safety issues in UK mental healthcare services, despite continuing serious failures in service provision. One crucial aspect of improving patient safety is the potential for involving users of health services, and their families, as a resource for increasing safety by providing feedback either during, or after, their care experience. Our work aims to explore service user and carer involvement in safety and interventions targeted at improving safety within a mental healthcare setting.

What are we doing?

NIHR Yorkshire and Humber PSTRC are excited to be collaborating with John Baker and Kathryn Berzins from the Mental Health Research Group at the School of Healthcare, University of Leeds. In 2012, the Yorkshire Quality and Safety Research (YQSR) Group published an empirically based framework of factors contributing to patient safety incidents in hospital settings—the Yorkshire Contributory Factors Framework (YCFF). Our collaboration has built on this earlier research, by modifying the framework to include important factors in mental healthcare (see Berzins et al 2018a). The image below gives an overview of the modified framework (click on image to enlarge).

Two additional factors ‘Social environment’ and ‘Service process’ were added to form the YCFF-MH. Definitions are presented in the image below (click on image to enlarge).

Additionally, the Patient Involvement in Patient Safety theme has been working with John and Kathryn to help progress our understanding of service user and carer involvement in mental healthcare safety. A survey of 185 UK service users, carers and health professionals explored the ease of raising concerns about safety and the potential for service users and carers to be involved in safety interventions (see Berzins et al 2018b). The image below gives an overview of these findings (click on image to enlarge).

Following on from the survey, and to to generate a richer picture of key safety issues, we carried out qualitative interviews with 13 service users, 7 carers and 14 health professionals (see Berzins et al 2020).

Patient and Public Involvement and Engagement

The focus for this research originally arose from discussion on social media involving John and Kathryn and a broad range of people in their networks, (including (ex)service users, family members, carers and professionals in a range of roles) about improving and understanding key safety issues in mental health services. The survey was developed following discussions with (ex)service users about patient safety in mental health settings. A number of (ex)service users were consulted about the specifics design and content of the survey. The interview study followed on from the survey, the findings was sent to interviewees to give them the opportunity to comment. Author Mark Brown is a mental health design researcher, writer and consultant. Mark has direct lived experience of mental health difficulty and experience of developing and delivering mental health projects with a strong participatory element. He has been involved for the duration of the study having been part of the initial application for funding, co-designed the survey, led the distribution through social media and subsequently provided input into the analysis and reporting of this study.

Next steps

Building on this research, we have been awarded funding from the National Institute for Health Research (NIHR) to develop and test a system to measure how safe service users on mental health wards are feeling in real-time, and make this information available to ward staff to help them manage safety. This 30 month project commenced in January 2020, and you can find out more about the project here.

Outputs and Impact   

Contact for more information: Dr Kathryn Berzins or Dr Gemma Louch

Ward Sonar Participant Information Sheet