Service user and carer involvement in mental health care safety: raising concerns and improving the safety of services

Kathryn Berzins,Gemma Louch,Jane K O’Hara,Mark Brown,John Baker

doi:10.1186/s12913-018-3455-5

Kathryn Berzins, Gemma Louch + Show 3 more

Open Access

https://doi.org/10.1186/s12913-018-3455-5

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Abstract

BackgroundPrevious research into improving patient safety has emphasised the importance of responding to and learning from concerns raised by service users and carers. Expertise gained by the experiences of service users and their carers has also been seen as a potential resource to improve patient safety. We know little about the ease of raising concerns within mental health services, and the potential benefits of involving service users and carers in safety interventions. This study aimed to explore service user and carer perceptions of raising safety concerns, and service user, carer and health professional views on the potential for service user and carer involvement in safety interventions.MethodsUK service users, carers and health professionals ( n= 185) were recruited via social media to a cross-sectional survey focussed on raising concerns about safety issues and views on potential service user and carer participation in safety interventions. Data were analysed using descriptive statistics, and free text responses were coded into categories.ResultsThe sample of 185 participants included 90 health professionals, 77 service users and 18 carers. Seventy seven percent of service users and carers reported finding it very difficult or difficult to raise concerns. Their most frequently cited barriers to raising concerns were: services did not listen; concerns about repercussions; and the process of raising concerns, especially while experiencing mental ill health. There was universal support from health professionals for service user and carer involvement in safety interventions and over half the service users and carers supported involvement, primarily due to their expertise from experience.ConclusionsMental health service users and carers experience difficulties in raising safety concerns meaning that potentially useful information is being missed. All the health professionals and the majority of service users and carers saw potential for service users and carer involvement in interventions to improve safety, to ensure their experiences are taken into consideration. The results provide guidance for future research about the most effective ways of ensuring that concerns about safety can be both raised and responded to, and how service user and carer involvement in improving safety in mental health care can be further developed.

Highlights

Previous research into improving patient safety has emphasised the importance of responding to and learning from concerns raised by service users and carers
The findings show that service users and carers find it difficult to raise concerns about safety
The reasons service users and carers put forward to explain these difficulties were that services were perceived as neither listening nor responding; service users were concerned about repercussions; the very process of raising concerns was perceived as challenging; and the difficulty of raising a concern while experiencing mental ill health was considered problematic

Summary

Introduction

Previous research into improving patient safety has emphasised the importance of responding to and learning from concerns raised by service users and carers. Expertise gained by the experiences of service users and their carers has been seen as a potential resource to improve patient safety. We know little about the ease of raising concerns within mental health services, and the potential benefits of involving service users and carers in safety interventions. This study aimed to explore service user and carer perceptions of raising safety concerns, and service user, carer and health professional views on the potential for service user and carer involvement in safety interventions. The resulting Francis Report [2] and the Keogh Report into quality of care across 14 other Trusts [3] stressed the need for patient involvement in the monitoring and inspection of services and service responses to complaints. Figures from 2015 show that of all complaints made to Trusts very few are upheld (1.1% of all complaints to mental health Trusts and 1.8% of those to hospital Trusts)

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