first do no harm

A Scottish health authority recently posted a job regarding quality assurance in the mental health services it offers. Buried in the job description was the revelation that its mental health hospital fields around 350 complaints a year, and over 900 adverse events.

Health Improvement Scotland defines an adverse event as “an event that could have caused, or did result in, harm to people or groups of people.” ¹

The National Library of Medicine in the US suggests that there are four types of adverse event: “medication side effects, injury, psychological harm or trauma, or death.” ²

Health services are run by human beings, and human beings make mistakes. Adverse events are inevitable for any health service anywhere in the world. The adverse event may be quite minor and the figures probably include near-misses.

But seriously: 900 adverse events in one year? In one hospital?? And as for complaints, I am guessing that these are recorded complaints and not just verbal feedback from patients on the floor. Surely something is not right if people are galvanised to submit formal complaints nearly every day.

Then there is the matter of whether or not the patient has agreed to the treatment in the first place. Many people who have been sectioned and medicated are done so explicitly against their will – at times held down and injected with drugs despite pleading with staff to stop (speaking from personal experience here, by the way.)

And let's dispel the myth that psychosis inevitably leads to disruptive or anti-social behaviour needing to be diffused. People are often doing no more than speaking aloud to themselves or wandering about randomly, absorbed in their own narrative.

I suspect that the bulk of the adverse events in this particular hospital amount to medication side effects and psychological harm or trauma (ironically.) Without more detailed data, one can only speculate.

But it does point to the question: why so many recorded adverse events, and why so many complaints? Health care prides itself for its benevolence: that treatment is in the patient's interest and will lead to an improvement in wellbeing. In psychiatry, this is simply not the case. Psychiatric treatment includes incarceration and brute force, medication against one's will, electroshock regimes at worst and routine dismissal at best.

There is a reason that many activists in the mental health field call ourselves psychiatric survivors. We have endured mistreatment in the name of treatment, and our work shines a light on the problems in and limitations of the current arrangements for mental healthcare. What would a mental health service look like, unriddled by adverse events and complaints?

photo by Enric Moreu on Unsplash

1. https://ihub.scot/project-toolkits/safety-principles/safety-principles/leadership-and-culture-principle/learning-from-adverse-events/

2. https://www.ncbi.nlm.nih.gov/books/NBK558963/