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Avoidable Harm
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7. neglectful, defensive or controlling frontline practice

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  • Lack of empathy for or engagement with the individual.

  • Inflexibility. 

  • Judgmental, stigmatising or discriminatory personal attitudes, including mental health status or diagnosis.

  • Assumptions about service user dishonesty or ‘maliciousness’.

  • Lack of understanding or assumptions about ethnicity, culture, religion, disability, and neurodiversity.

  • Poor communication and communication skills. 

  • Controlling behaviour, coercion, or misuse of power.

  • Disempowering, exclusionary decision making.

  • Risk aversity and restrictive practices.

  • Service users being ‘set up to fail’.

  • Practitioners not listening or acting.

  • Failure to give information or explanations about entitlements or support options. 

  • Employing ‘tick-box’ rather than human, person-centred approaches. 

  • Not accepting responsibility for harmful failings or mistakes. 

  • Adversarial frontline relationships with interactions feeling like interrogations.

  • ‘Gatekeeping’ and rationing role.

Systemic    |    Relational

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"You've got a stranger who's dismissing the most intimate details of your life and until we can look at how better to treat people. how to...assess them, it’s never gonna work."

"I was brought up in the care system, and she put, 'she chooses to have no contact with friends and family'. And that really upset me. To them it was a choice."

Please visit us on a desktop!

A model of service user experiences of avoidable harm in mental health social care, the impacts of harm caused and service user recommendations for ways to minimise harms.

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Principal Investigator: Dr Sarah Carr

Co-Investigator: Dr Angela Sweeney

Co-Investigator: Tina Coldham

Research Assistant: Georgie Hudson

Design & illustrations: Traumascapes

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This resource is based on independent research funded by

the National Institute for Health Research School for Social Care Research (NIHR SSCR). The views expressed are those of the authors and not necessarily those of the NIHR SSCR,the National Institute for Health Research or the Department

of Health and Social Care.

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