Patient safety incidents in mental health residential services: a multicenter, crosssectional, survey-based study

Introduction: While patient safety in general hospitals is well-researched, residential mental health services have received less attention. Psychiatric patients and staff working in such facilities face unique and complex risks. This study aims to explore and describe the frequency and characteristics of patient safety incidents (PSIs) experienced by professionals working in a cohort of Italian mental health residential services. Methods: A multicenter, cross-sectional, questionnaire-based observational study was conducted involving workers from 68 psychiatric mental health services from seven different Italian provinces. A total of 159 respondents, including both healthcare and non-healthcare professionals, took part in the study. Participants reported incidents personally experienced (FHE) or reported by colleagues (CRE) over the previous 12 months, using a taxonomy adapted from the World Health Organization's Conceptual Framework for the International Classification for Patient Safety. Data was analyzed using descriptive statistics and zero-inflated models to identify associations between respondent characteristics and reporting behaviors. Results: A total of 4,432 FHE and 4,807 CRE were reported. The behavior-related events were the most frequently reported, followed by incidents related to organizational or infrastructure issues, and medication errors. Secondary analyses suggested that facilities with more than ten employees had significantly higher rates of both FHE and CRE. Furthermore, residential facilities showed a higher incidence rate of CRE compared to non-residential ones, and non-healthcare workers reported witnessing fewer incidents to colleagues (28%) compared to healthcare workers. Significant variability was also observed across different provinces. Conclusion: Residential mental health services experience a high incidence of PSIs, suggesting a risk profile distinct from general hospital settings. The predominance of behavior-related incidents corroborates the hypothesis that primary risks are mainly driven by relational dynamics. The findings highlight that both healthcare and non-healthcare staff are exposed to significant risks, suggesting the need of inclusive and comprehensive safety interventions. Consequently, specific training programs focused on relational risk management, de-escalation, and empathic communication are essential for all workers employed in these settings.