King's College London

Research portal

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

Research output: Contribution to journalReview articlepeer-review

Phoebe Averill, Charles A Vincent, Gurpreet Reen, Claire Henderson, Nick Sevdalis

Original languageEnglish
Pages (from-to)51-63
JournalHealth Expectations
Issue number1
Early online date12 Nov 2022
E-pub ahead of print12 Nov 2022
Published12 Nov 2022

Bibliographical note

Funding Information: This project is supported by the Health Foundation's grant to the University of Cambridge for The Healthcare Improvement Studies Institute (THIS Institute), grant number PHD‐2018‐01‐026. Open Access publication of this article was made possible by King's College London's ‘Read & Publish’ agreement with Wiley (Wiley—Jisc). Nick Sevdalis' research is supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South London at King's College Hospital NHS Foundation Trust. Nick Sevdalis is a member of King's Improvement Science, which offers co‐funding to the NIHR ARC South London and comprises a specialist team of improvement scientists and senior researchers based at King's College London. Its work is funded by King's Health Partners (Guy's and St. Thomas' NHS Foundation Trust, King's College Hospital NHS Foundation Trust, King's College London and South London and Maudsley NHS Foundation Trust), and the Guy's and St. Thomas' Foundation. The views expressed in this publication are those of the author(s) and not necessarily those of the Health Foundation, THIS Institute, the NIHR or the Department of Health and Social Care. Publisher Copyright: © 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.


King's Authors


Introduction: Patient safety problems stemming from healthcare delivery constitute a global public health concern and represent a pervasive barrier to improving care quality and clinical outcomes. However, evidence generation into safety in mental health care, particularly regarding community-based mental health services, has long fallen behind that of physical health care, forming the focus of fewer research publications and developed largely in isolation from the wider improvement science discipline. We aimed to investigate the state of the field, along with key conceptual and empirical challenges to understanding patient safety in community-based mental health care. Methods: A narrative review surveyed the literature to appraise the conceptual obstacles to advancing the science of patient safety in community-based mental health services. Sources were identified through a combination of a systematic search strategy and targeted searches of theoretical and empirical evidence from the fields of mental health care, patient safety and improvement science. Results: Amongst available evidence, challenges in defining safety in the context of community mental health care, evaluating safety in long-term care journeys and establishing what constitutes a ‘preventable’ safety problem, were identified. A dominant risk management approach to safety in mental health care, positioning service users as the origin of risk, has seemingly prevented a focus on proactive safety promotion, considering iatrogenic harm and latent system hazards. Conclusion: We propose a wider conceptualization of safety and discuss the next steps for the integration and mobilization of disparate sources of ‘safety intelligence’, to advance how safety is conceived and addressed within community mental health care. Patient and Public Contribution: This paper was part of a larger research project aimed at understanding and improving patient safety in community-based mental health care. Although service users, carers and healthcare professionals were not involved as part of this narrative review, the views of these stakeholder groups were central to shaping the wider research project. For a qualitative interview and focus group study conducted alongside this review, interview topic guides were informed by this narrative analysis, designed jointly and piloted with a consultation group of service users and carers with experience of community-based mental health services for working-age adults, who advised on key questioning priorities.

View graph of relations

© 2020 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454