‘A broken system’? Service user definitions of avoidable social and psychological harm in mental health social care and recommendations for its minimization in England

Mental health social care (MHSC) is an under-researched area, with little investigation of avoidable social and psychological harm. Understanding this type of harm from service user perspectives is critical for identifying effective strategies for harm minimization. This survivor-controlled research aimed to generate a service user-defined model of avoidable social and psychological harm in community-based MHSC in England, and gather recommendations for its minimization. We first conducted an evidence synthesis to generate an initial model. To refined and finalize the model and explore recommendations, we held two focus groups and carried out a survey with MHSC service users. The final model includes seven sources of avoidable social and psychological harm: barriers or burdens caused by systems/bureaucracy; stigma and discrimination; fragmented services; disruption to or lack of appropriate support; oppressive, controlling, or defensive organizational cultures and systems; serious misconduct or sexual abuse by staff; and neglectful, defensive, or controlling frontline practice. Nine recommendations for harm minimization are made, including: practice improvements; recruitment, education and training; monitoring and regulation; complaints processes; and independent advocacy. Further research is needed to investigate the scale of these harms, who is at particular risk, and the implementation of service user-generated harm minimization recommendations.