Institutional Abuse, Neglect and Harm in UK Community Mental Health Services: A Scoping Review of the Peer-Reviewed Evidence

Background

Statutory guidance relating to the prevention of institutional abuse, neglect and harm does not reflect the contemporary organisation of UK community mental health services. Historical associations with inpatient and residential settings have created a practice and conceptual gap despite lived experience testimony, inquiries and media reports attesting to the phenomena in community mental health services.

Aim

To describe the peer-reviewed evidence on the phenomena of institutional abuse and neglect associated with harm in UK community mental health services for adults of working age.

Methods

We searched nine indexed databases for primary and secondary research (any methodology), theoretical papers and commentaries published between 2000 and 2025. We extracted and charted papers' substantive characteristics and findings, and conducted a descriptive synthesis to identify the phenomena's characteristics and potential causal factors.

Findings

Twenty-two papers met inclusion criteria, consisting of primary research utilising qualitative or observational methods (n = 12), secondary research (n = 6), lived experience narratives (n = 3) and a community consultation (n = 1). Institutional neglect was the principal phenomenon described, with gaps and inadequacies in accessing institutional provisions a primary mechanism. Associated harms included suicide, homicide and psychological harms. People diagnosed with a personality disorder, labelled ‘hard to engage’ and who self-harm were amongst the population affected. Inter-related potential causal factors spanned national, institutional and individual levels, with resources a primary factor.

Conclusions

Our scoping review advances conceptual knowledge about the characteristics and potential causal factors of institutional abuse, neglect and harm in UK community mental health services. This provides a robust foundation for future research endeavours to inform safeguarding and patient safety policy and practice.

Patient and Public Contribution

The review was conceptualised, led and conducted by lived experience researchers who are current and/or previous users of mental health services. A Lived Experience Advisory Group (LEAG) was involved in the review's synthesis, manuscript preparation and are review authors.