Balancing harms in support of recovery

Abstract

Background: Harm in mental health has traditionally been viewed as “unambiguous” and measured in terms of suicide, self-harm, self-neglect and violence. In order to develop an organisational patient safety strategy, one Trust engaged with service users, carers and senior clinicians and managers in order to understand how they define harm.

Aim: To explore the meaning of harm in a mental health and learning disabilities setting.

Method: This paper describes the outcome of service improvement work with service users, carers, senior clinicians and managers at one Trust to determine what harm meant to them.

Results: Harm is a concept which is broader than elements currently seen within organisational patient safety metrics and clinical risk assessments.

Conclusions: Taking into account the diverse feedback received about what constitutes harm, a more inclusive definition emerges which could be incorporated into a new framework for risk management, balancing risk of harms across multiple dimensions. This approach has the potential to bring together consideration of the risk and recovery agendas.

• Harm
• mental health
• recovery
• risk
• safety

Acknowledgements

The authors would like to acknowledge the contribution of the service users and carers who participated in the focus group described; Leanne McCrindle who facilitated the discussion and of the members of Tees, Esk and Wear Valleys NHS Foundation Trust’s Quality and Assurance Committee for their contribution towards the model described. We would also like to thank the anonymous reviewers for their valuable comments on earlier versions of this article.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.