Thematic analysis of institutional abuse

Purpose The Independent Review of Greater Manchester Mental Health NHS Foundation Trust published in 2024 re-emphasised that the abuse of patients within psychiatric institutions continues to occur. The findings and recommendations of inquiries are often so specific to the individual context that general principles for application to other institutions cannot be drawn. To reduce the likelihood of patient abuse, it is imperative that such principles are identified. This study aims to identify the common themes contributing to patient abuse across institutions and construct a generalisable framework that enables analysis and mitigation of underlying causes by different health-care professionals. Design/methodology/approach Using thematic analysis, the authors qualitatively analysed inquiries into six psychiatric institutions. Inquiries were selected to represent a variety of types of institutions (learning disability, general psychiatric and forensic services) across a wide timescale. Findings The identified thematic structure comprised three levels at which processes relevant to the behaviour of concern operate (“Proximal”, “Organisational” and “System” Dynamic), with a fourth, cross-cutting theme of how concerns are responded to. Originality/value This study has enabled the development of a novel and generalisable framework to help understand the levels at which processes contributing to abuse occur. The framework can be used to assess and mitigate the incidence of abuse within psychiatric institutions, as well as educate and empower others to recognise when abuse may be occurring. It will benefit from further empirical testing to support its use.