To what extent are patients involved in researching safety in acute mental healthcare?

Abstract

Background There is a growing need to involve patients in the development of patient safety interventions. Mental health services, despite their strong history of patient involvement, have been slow to develop patient safety interventions, particularly in inpatient settings. Methods A systematic search was undertaken of both academic and grey literature. Whilst no lay member of the team worked directly on the review, they were part of the project steering group which provided oversight throughout the review process. This included people with lived experience of mental health services. From a research perspective the main focus for lay members was in co-producing the digital technology, the key project output. Smits et al.’s (Res Involv Engagem 6:1–30, 2020) Involvement Matrix was used to taxonomise levels of patient involvement. Studies were included if they were set in any inpatient mental health care context regardless of design. The quality of all selected studies was appraised using Mixed Methods Appraisal Methodology (MMAT). Results Fifty-two studies were classified, synthesised and their levels of patient involvement in the research and development of patient safety interventions were taxonomised. Almost two-thirds of studies (n = 33) researched reducing restrictive practices. Only four studies reported engaging patients in the research process as decision-makers, with the remaining studies divided almost equally between engaging patients in the research process as partners, advisors and co-thinkers. Just under half of all studies engaged patients in just one stage of the research process. Conclusion Involvement of patients in researching patient safety and developing interventions in an inpatient mental health context seems diverse in its nature. Researchers need to both more fully consider and better describe their approaches to involving patients in safety research in inpatient mental health. Doing so will likely lead to the development of higher quality safety interventions.

Conceptual and practical challenges associated with understanding patient safety within community‐based mental health services

“…Likewise, we support calls for a bottom‐up approach to safety in mental health care, both in terms of its conceptualization 85 and improvement initiatives, with the involvement of service users, carers and frontline staff 8,45 . Historically, safety efforts may have been driven by top‐down policy and regulations, to the detriment of aims to produce authentic improvements to service users' care 86 .…”

“…Likewise, we support calls for a bottom‐up approach to safety in mental health care, both in terms of its conceptualization 85 and improvement initiatives, with the involvement of service users, carers and frontline staff. 8 , 45 Historically, safety efforts may have been driven by top‐down policy and regulations, to the detriment of aims to produce authentic improvements to service users' care. 86 In integrating diverse sources of safety intelligence, we will be best placed to improve care, by bringing together findings which are embedded in patient safety theory alongside those grounded in the reality of practice.…”

“…The corresponding risk management culture has resulted in a narrow safety research agenda, centred around topics such as suicide, self‐harm and violence. Indeed, a recent review exploring patient involvement in the development of safety improvement interventions in acute inpatient mental healthcare settings identified that almost two thirds of included studies were concentrated on the reduction of restrictive practices, rather than on interventions aimed at advancing the therapeutic culture of these settings 45 . Where resource allocation, team culture and training are concentrated primarily around maintaining personal and public safety, 35,46 there may be overreliance on coercive or restrictive interventions, curtailing a broader focus on proactive promotion of safe care 33 .…”

Lived experience and family engagement in psychiatry research: A scoping review of reviews

“… 28 , 30 , 31 , 36 , 39 , 43 Other specific populations included people with autism or neurodevelopmental disorders, 35 people who use drugs, 41 people in forensic mental health services, 42 and general mental health in acute care settings. 29 Several articles focused on mental health research in general. 1 , 9 , 32 , 33 , 34 , 40 , 45 One review sought articles specific to PWLE/F engagement in mental health research, specifically in low or middle‐income countries, but did not find any.…”

Promoting a Patient-Centered Understanding of Safety in Acute Mental Health Wards: A User-Centered Design Approach to Develop a Real-Time Digital Monitoring Tool

“…We conducted (1) a systematic review [27] and evidence scan, (2) semistructured interviews with health professionals [28] and patients, and (3) stakeholder engagement sessions (see Textbox 1).…”