The situation for people with mental health problems as a group of disabled people who experience targeted violence and abuse is a complex one. Disabled people, particularly those with mental health problems, are at higher risk of targeted violence and hostility with few effective evidence‐based prevention and protection strategies. Achieving effective safeguarding for adults with mental health problems is characterised by differential attitudes to and understandings of abuse by safeguarding practitioners, as well as systemic issues arising from multi‐agency working. “Keeping Control” was a 16‐month user‐led, co‐produced exploratory qualitative study into service user experiences of targeted violence and abuse that was examined in the context of Care Act 2014 adult safeguarding reforms in England. User‐controlled interviews of mental health service users (N = 23) explored their experiences and concepts of targeted violence and abuse, prevention and protection. Preliminary findings from these interviews were discussed in adult safeguarding and mental health stakeholder and practitioner focus groups (N = 46). The data were also discussed via two facilitated Twitter chats (responses N = 585 and N = 139). Mental health service users’ experiences and concepts of risk from others, vulnerability and neglect can be different to those of practitioners but should be central to adult safeguarding. Histories of trauma, multi‐factorial abuse; living with fear and stigma as well as mental distress; the effects of “psychiatric disqualification” and individual blaming should be addressed in adult safeguarding in mental health. Fragmented responses from services can mean a person becomes “lost in the process”. Staff can feel disempowered, afraid or lacking in confidence to “speak up” for individuals in complex service systems with poor communication and lines of accountability. Adult safeguarding practitioners and stakeholders need to be confident, accessible and respond quickly to service users reporting incidents of targeted violence and abuse particularly in closed environments such as wards or supported housing.

This paper explores the methodological aspects of a user-led study investigating service user experiences of targeted violence and abuse (often called 'hate crime'). 1 'Keeping Control' was a 16-month qualitative study, undertaken in the context of adult safeguarding reforms in England. The study was partly undertaken to inform the implementation of 'The Care Act 2014: Statutory Guidance on Making Safeguarding Personal' England. 2[updated] These new policy approaches to adult safeguarding under the Care Act 2014 determine that safeguarding is 'everybody's business' and that it should become more outcome-focused and person-centred. 3 By collecting data on service user views and experiences, the research sought to address a gap in research and practice knowledge relating to targeted violence, abuse and hostility against people with mental health problems.

Background.The aim of this research scoping review was to assemble an evidence base for the UK on mental health service user experiences and perspectives on mental health-related targeted violence and hostility (‘disability hate crime’). It also aims to address some of the gaps in the knowledge on risk management, help-seeking and prevention from the perspectives of those who experienced targeted violence and hostility because of their mental health problems or psychiatric status.Methods.Seven key mental health and social care bibliographic databases were searched for relevant UK research studies from 1990 until 2016. Grey literature was identified through online searches. A scoping review charting approach and thematic analysis methodology were used to analyse the studies.Results.In total 13 studies were finally included, over half of which used survey methods. All studies included people with experiences of mental health problems. The studies provide information on: the types of potential hate crime; indicate where incidents take place; give some insight into the victims’ relationship with the perpetrators; the location of incidents as well as the psychological, social, financial and physical impacts on the victim; the types of help-seeking behaviours adopted by the victims; a range coping strategies that people with mental health problems adopted in response to experiences of targeted violence or abuse.Conclusion.This scoping review provides a UK-based overview of mental health service user concepts and experiences of mental health-related targeted violence and hostility (‘disability hate crime’). It reveals some specific issues relating to mental health and disability hate crime. Further investigation into disability hate crime with a specific focus on mental health is required. This is a UK-based overview, which offers a useful comparator for researchers, practitioners and policy-makers internationally.

People with lived experience of mental distress experience high rates of targeted violence and hostility based on their mental health status. This user-led study explored practitioners' perceptions and experiences of supporting service users in these challenging situations and considered the role of adult safeguarding. Six focus groups with practitioners (n=46) enabled them to respond to data documenting service user's experiences. This process facilitated knowledge exchange between the research team and practitioners on the ground. The findings illuminate a complex picture where lack of effective structures and processes mitigate against service users in these difficult situations. Practitioners need to invest in trusting relationships, to optimise resources and actively help service users with lived experience of mental distress to find their own solutions. These should involve collaborative empowerment whereby feelings of isolation and rejection can be replaced with hope, a sense of agency and belief in personal control.

No abstract