Keeping control: Exploring mental health service user perspectives on targeted violence and hostility in the context of adult safeguarding

Introduction

Many people living with mental health problems are at high risk of targeted violence and abuse. Most adult safeguarding research in mental health has focused on service and practitioner perspectives.

Objectives

Set in England, this research was a qualitative exploration of service user experiences and concepts of targeted violence and abuse (often termed ‘hate crime’) on the grounds of mental health status. It also aimed to capture mental health and adult safeguarding practitioners and stakeholder responses to these mental health service user experiences and concepts.

The Care Act 2014: Statutory Guidance on Making Safeguarding Personal reforms aim to make adult safeguarding person-centred and outcomes-focused. The study sought to inform policy
implementation and practice development from a mental health service user perspective.

Methods

The study used interconnected work streams with different methods:

• a literature scoping review;
• user-controlled interviews with self-selecting mental health service users with experience of targeted violence and abuse recruited through user-led organisations and networks (n=23, 92% women, 2 proxy carer respondents);
• practitioner-led adult safeguarding and mental health practitioner and stakeholder focus groups discussing preliminary service user interview findings (n=46);
• practitioner-led discussion of findings via two sessions on Twitter using @MHChat in December 2016 (n=585) and June 2017 (n=139); and
• a ‘sense making’ stakeholder event (n=42) facilitated discussion of implications of the findings for adult safeguarding in mental health.

The study was mental health service user led. Over half the team identified as service user or survivor researchers, including the Principal Investigator. It was co-produced with two practitioner researchers in a team working to a set of shared principles and methods derived from survivor and emancipatory research.

Findings

• Living in fear of abuse and feeling unsafe in all settings was common across the service users interviewed
• Neglect by mental health staff can be experienced as targeted abuse by services users
• Staff reported feeling disempowered, afraid to take responsibility, lacking in confidence to advocate for individuals or to “speak out” about bad practice in such a system and in mental health or social work “blame cultures”
• There should be more emphasis on user-led prevention and protection, with safety planning and safeguarding outcomes agreed with the service user when care planning
• Service users report they need mental health and adult safeguarding practitioners, police and housing officers to listen and believe them; be accountable and responsible; to take ownership of the issue; and help them pursue justice.

Resources

Journal papers

Carr S, Hafford-Letchfield T, Faulkner A, Megele C, Gould D, Khisa C, Cohen R, Holley J (2019) “Keeping Control”: A user‐led exploratory study of mental health service user experiences of targeted violence and abuse in the context of adult safeguarding in England, Health and Social Care in the Community, First published online 30 June 2019.

Faulkner A, Carr S, Gould D, Khisa C, Hafford-Letchfield T, Megele C, Cohen R, Holley J (2019) ‘Dignity and respect’: An example of service user leadership and co‐production in mental health research, Health Expectations, First published online 26 September 2019.