A systematic review of patient safety in mental health: a protocol based on the inpatient setting

Patient safety refers to the prevention of harm as a result of receiving healthcare services [1]. This includes events such as mistakes during procedures and accidents that happen during hospital stays. There has been growing interest in patient safety as a discipline in recent years [2, 3]. The vast majority of this body of research to date has focused on physical healthcare; however, it cannot be assumed that findings based upon physical health patients can be applied to mental health patients, disorders and settings. This is due to the different challenges that are presented in this specialised area of care [4].

There has been exploration of specific adverse events that occur within acute mental health facilities, such as suicide and self-harm [5‐8], with prevalence rates and precipitating factors examined regularly. There have also been aspects of patient safety touched upon in quality of care research within mental health facilities, for example, audit and quality of care intervention studies [9, 10]. A systematic review has also been conducted collating the literature regarding quality of care for institutionalised mental health patients [11]. This review highlighted incidents such as restraint and seclusion as important aspects of quality of care but did not discuss patient safety as a whole. Although patient safety can be seen as a subset of quality of care, they are not synonymous, with research on the quality of healthcare sometimes lacking a focus on patient safety issues [12].

Research involving patient safety systems and management as a whole is lacking, as are attempts to apply patient safety as a complete concept directly to mental health research [4]. This may be because mental health in general has been viewed as a neglected area in which patients may be less likely to have a voice when it comes to their care and safety [13]. It has also been suggested that the social stigma surrounding mental health issues has the potential in itself to contribute to patient safety being neglected [4].

A Canadian Report published in 2009 [4] is the only review of the literature to our knowledge that has explored the role of patient safety in mental health. This work makes a valid contribution to the emerging field of patient safety in mental health but has flaws that require addressing. Firstly, the literature review is now out of date, with evidence being collected in 2008. Secondly, the work focussed on a pre-specified set of patient safety incidents, so other areas of patient safety concern could have been neglected. Finally, the review was not published in an academic journal as far as we are aware, and there is a lack of methodological detail given in the report, limiting readers' understanding of its methodological rigour. The review does not specify any independent reviewing process, inter-reviewer agreement calculation, inclusion or exclusion criteria or assessment of the quality of the research included. This restricts broader access to the findings and makes it difficult to ensure that the processes of article selection and data extraction were conducted systematically. It is for these reasons that it is thought important to develop the methodology by undertaking a full systematic review as a first step towards a broader research programme on patient safety in mental health at the NIHR Imperial Patient Safety Translational Research Centre (PSTRC). The importance of high-quality systematic reviews in the patient safety research field has been emphasised [14].

This systematic review aims to bring together research within mental health to provide a clear picture of what we know about patient safety within this context. In order to deliver high-quality care to service users, it is essential that a stronger understanding of patient safety in mental health is developed and disseminated.