“Safety” in mental health care

16 Jul


Safety Dance - Men Without Hats

Safety Dance – Men Without Hats

When you think “safety”, what comes to mind? Seeing someone on top of a rickety ladder reaching out to wash a window perhaps. Or putting a guard rail along a high pathway or using an oven mitt to pull out a hot grill pan. Protections from physical harm. But what does “safety” mean in the context of mental health care?

Caring for people with mental health problems should naturally – since the pain and suffering is mental – involve alleviating mental distress. So often, however, the terms in which mental health is spoken and the means by which people are assessed and treated in psychiatric care appear to be almost entirely physical: assessing someone from their demeanor; treating them with drugs; locking them on a psychiatric ward. I’ve speculated about that before (here). Sadly, I haven’t heard any contradiction to that suggestion yet.

Today, it was announced by psychiatrist Professor Louis Appleby that this year’s annual “safety in mental health care” report was being launched. There would also be a tweet chat, on the hashtag #ncish14. What could the report be about and would it deal purely in physical aspects of mental health care?

The report, it turned out, was about death: suicide, homicide and sudden deaths in mental health patients. It was a serious and sobering report about tragic deaths which also dispelled myths about “dangerous mental patients” (a tiny proportion of homicides are by people with mental health problems; but a far higher proportion of suicides) and offered concrete recommendations to reduce the rates of all three. Mental health charities Rethink Mental Illness and Mind released a statement about the report.

What struck me in addition, however, were two things: first that, in mental health, the word “safety” seemed to be a euphemism for “preventing deaths” rather than, say, patients feeling safe and cared for in their distress or alleviating distress; and that the only thing measured and reported nationally on an annual basis in relation to mental health was a physical outcome, namely death.

I joined in the tweet chat and exchanged some tweets with the NCISH (National Confidential Inquiry into Suicide and Homicide by People with Mental Illness in the Centre for Mental Health and Risk at the University of Manchester) and with Professor Appleby. I’m still pondering this and may add to this blog post later. But, in the meantime, I’m left with the impression that – hundreds of years since practices such as mechanical restraint, confinement in madhouses and cold baths began to be condemned – mental health care is still viewed, treated and measured in largely physical terms.



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Related links



The report and related documents:


On twitter:








5 Responses to ““Safety” in mental health care”

  1. Borderlion 16 July 2014 at 11:30 pm #

    It sounds like the conversation falls woefully short of what’s needed. When I think of safety and mental health I think of how unsafe I have felt on inpatient wards thanks to staff members being bullies, and being beaten up by the police during an episode of mental breakdown.

  2. LH 17 July 2014 at 5:15 am #

    Reblogged this on Healing hurts and commented:
    Very astute thoughts here.

  3. thebernardbert 27 July 2014 at 8:45 pm #

    Reblogged this on The Bernard Bert.

  4. StrongestSmile 8 August 2014 at 11:13 pm #

    You have absolutely hit the nail on the head here in this blog post, safety is always related to suicide or homicide in mental health but those of us who have experienced services know that its about so much more. Easing the distress felt by people should always feature in the safety planning, I find the ImROC co-production view on safety planning rather than risk assessment is a good step in the right direction as it puts the service user at the centre of their own care and focuses on long term goals rather than just ‘avoiding death’.
    Keep up the wonderful writing I enjoy your posts 🙂

  5. kermit99 9 August 2014 at 2:51 am #

    Jesus – You should have seen the facebook thread on safety -in the mental health nursing group. It was pretty distressing…I’d send the link,…but you have to be approved to join to actually get to the nitty gritty. Frankly – I was disgusted by the ignorance.

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