Safer Care

Improving safety in mental health

Mental health service users are harmed every day, despite the best efforts of the staff who support them.

Everyone involved in providing mental health services can help to reduce this harm and improve the safety of care they provide.

The Safer Care team is working with NHS trusts across England to help staff develop the passion, skills and confidence to improve patient safety in mental health.
Mental Health Trigger Tool (MH TT)
Work is underway to develop a tool to measure the occurrence of harm within mental health settings.  The development of this measure initially focused upon a Trigger Tool approach, whereby triggers (or clues) are used to identify potential harms.  This is an approach which has worked successfully within acute medical/surgical settings [link], for example, where the administration of naloxone is a clue to harm from the over-use of opiates.  Work within primary care suggests that this approach transfers to the measurement of harm within these settings.

However, the development group for the mental health measurement of harm tool found two key challenges: firstly, in mental health, the term ‘trigger’ is used to describe a precursor to an event, for example, a significant anniversary. This caused confusion when seeking to describe the tool.  Secondly, after testing 200 sets of notes using a trigger tool approach, the group identified that those aspects that were considered harms in mental health were referred to directly, for example extra-pyramidal side-effects, self-harm or assault.  The development group is therefore now focused on refining a measure of harm using a targeted case-note review approach.

The group has also recognized the importance of the patient experience approaches to the measurement of harm.  Early work has noted aspects such as intimidation, feeling listened to, medication side-effects and being attacked, only some of which can be measured using a case-note based tool.  The Group therefore feels that the holistic measurement of harm must look at both case-note and patient experience methodologies.

With this information to hand it will be possible for mental health trusts to measure the impact of system and process improvements implemented to eliminate harm to patients. 
Summary of rapid literature review
Click here for a summary of a rapid literature review that was conducted to understand what is known about adverse events in mental health. 

More information
For more information on improving patient safety in mental health or to get involved in our work, please contact Safer Care.
You may also wish to download a copy of our general practice and mental health improving patient safety newsletter.