Patient Safety in Mental Health Services (part of GM PSTRC)

Project overview
This project aims to improve patient safety in mental health services by identifying the components of services which are associated with lower suicide and self-harm rates. We plan to explore the barriers and facilitators to psychosocial assessments and psychological therapies for people who self-harm (see Study 1). We are also examining specific aspects of services and practices that are associated with lower suicide rates (see Study 2). 

We hope that the results of our studies will improve patient safety in mental health services, increase access to psychosocial assessments and psychological therapies for people who have harmed themselves, reduce repeat self-harm, and ultimately contribute to suicide prevention strategies. 

Study: Psychological services for people who self-harm
Self-harm includes self-poisoning, self-cutting, and other forms of self-injury and is a common reason for presentation to community and hospital services. Repeated self-harm and suicide are key outcomes for patient safety in mental health services. In one year of follow-up, one in six people who present with self-harm will have repeated and one in 50 will have died by suicide. The period of highest risk is soon after the index episode and so any intervention should be provided promptly. The National Institute for Clinical Guidelines (NICE) recommends that all patients receive a psychosocial assessment on presentation to hospital with self-harm (NICE, 2011). Good quality assessments are an important part of clinical management and may be beneficial in reducing repeat self-harm. The NICE guidelines also recommend that 3 to 12 sessions of psychological therapy should be available following a self-harm episode: A Cochrane review has concluded that rates of repetition might be reduced by 30% by the provision of these psychological interventions. 

However, there are significant variations in the proportion of people who receive a psychosocial assessment and no service provides such psychological interventions routinely, which represents a significant deficit. We will look at the gaps between evidence and practice in providing routine psychological treatments following self-harm and why psychological therapies are not being provided. We will investigate how early translational interventions can be developed and tested. Several research methods (e.g., analysis of routinely collected data, interviews, audits, focus groups) will be used to enhance our understanding of the gaps in existing service provision and potential barriers. 

We will refine our results to develop translational interventions to investigate whether such approaches lead to an increase in the number of people receiving psychosocial assessments and psychological treatments.

Study 2: Components of a safer mental health service
Our research seeks to improve patient safety in mental health services by identifying aspects of patient care that are associated with a reduction in suicide and self-harm rates. In a previous study, we examined suicide rates in England & Wales before and after the implementation of a series of recommendations in NHS mental health services. We found that provision of 24-hour crisis care, policies on dual diagnosis (i.e., for individuals with mental health problems and substance misuse), and multidisciplinary reviews after a death by suicide were associated with improved patient safety, as evidenced by reduced suicide rates. We also looked at the links between organisational factors, such as staff turnover and general levels of event reporting, and patient suicide rates. This research suggested that these different changes to mental health services were linked with a reduction in patient suicide risk. However, this research also showed that various recommendations were implemented during the same time period. Therefore, it is hard to understand which service changes are associated with the greatest reduction in suicide rates. In addition, further research is needed to understand which specific aspects of service changes have the greatest impact on patient safety. Therefore, the current project will use a range of research methods (e.g., document review, observations, interviews) to to develop a more detailed understanding of the key aspects of the service recommendations that contribute to patient safety. We will also investigate how organisational factors (e.g., staff turnover) can influence the impact that these service changes have. Findings will inform the development of a practical 'how to' guide in order to support mental health services in implementing these practices to thereby enhance patient safety. Results from the study will be shared with public and academic communities. The details of how this will be achieved shall be decided through collaboration with our involvement and engagement partners. 


Research staff 
The Patient Safety in Mental Health Research is part of the NIHR Greater Manchester Patient Safety Translational Research Centre (http://www.patientsafety.manchester.ac.uk/). We lead the work on self-harm and suicide prevention. The lead researchers are Drs Donna Littlewood and Leah Quinlivan. The theme leads are Professors Roger Webb and Nav Kapur. The project team are members of the Centre for Mental Health and Safety and work closely with the National Confidential Inquiry into Suicide and Safety in Mental Health, the Manchester Self-Harm Project, and the Epidemiological Mental Health Research Group.