Developing Safe Care in Mental Health for Children and Young People: Drawing on UK Experience for Solutions to an Under-Recognised Problem

Abstract

Safe care in child and adolescent mental health is an under-developed concept. A new model for conceiving of potential harm and embedding a safety culture has been suggested, which comprises three levels of harm and a range of initiatives designed to promote safety. At the first level, harm may be caused by lack of engagement with appropriate help; this is a critical issue for child mental health where key barriers include stigma, lack of knowledge and, crucially, lack of provision. Initiatives to address barriers to help-seeking include online tools for education and/or support. Once in contact with services, premature disengagement must be carefully monitored, particularly when this is mediated by parent/carer choice when it may be considered as a safeguarding issue. At the second level, harm may be caused by ineffective practice. Effective practice is increasingly conceived as involving a combination of evidence-based practice, service user preference, and regular review of outcomes and feedback. Initiatives involving collaborations of service providers to work to common standards in line with best practice are increasingly aligned and collaboratively seek to support best practice in this regard. However, this needs to be supported by adequate staffing and infrastructure for safe practice. At the third level, harm may be caused by adverse events. Serious case reviews following a major incident or child death have highlighted possibilities of key learning such as the need for greater review of integration of services, and there is an emerging research agenda looking at the iatrogenic impact of talking therapies. Using and integrating national and international data sets should help support the review of such issues, and the emergence of new models of care and payment system work will provide opportunities for setting in place mechanisms to minimise adverse events and embed a more explicitly safety-focused culture.