Imagine walking into a mental health home where staff and residents live together. A new survey asked 159 workers from 68 different homes across seven Italian provinces about safety problems they saw in the last year. They wanted to know if the size of the home or who worked there changed how often things went wrong. The answer was yes, and the numbers were surprising. In total, workers reported 4,432 incidents they saw personally and 4,807 they heard about from colleagues. Behavior-related events, like conflicts or agitation, were the most frequent type of problem. The study also found that homes with more than ten employees had significantly higher rates of these incidents compared to smaller ones. Additionally, residential facilities saw more incidents reported by colleagues than non-residential ones. Non-healthcare workers, like cleaners or cooks, reported witnessing fewer incidents to colleagues compared to healthcare workers, who only reported 28% fewer incidents. This suggests that everyone in the home matters for safety, not just the doctors and nurses.
Observational survey of 159 Italian mental health workers links larger facility size to higher patient safety incident reportingDid you know larger mental health homes saw more safety incidents than smaller ones?
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This multicenter, cross-sectional, survey-based observational study evaluated the frequency and characteristics of patient safety incidents (PSIs) among workers from 68 psychiatric mental health services across seven Italian provinces. The sample included 159 respondents comprising both healthcare and non-healthcare professionals. Data covered PSIs personally experienced (FHE) or reported by colleagues (CRE) over the previous 12 months. Comparisons were made between residential and non-residential facilities, as well as between healthcare and non-healthcare workers.
A total of 4,432 FHE and 4,807 CRE were reported. Behavior-related events were the most frequently reported incident type. Incidence rates were significantly higher in facilities with more than ten employees for both FHE and CRE. Residential facilities demonstrated a higher incidence rate of CRE compared to non-residential ones. Additionally, non-healthcare workers reported witnessing fewer incidents to colleagues (28%) compared to healthcare workers.
Safety analysis noted that PSIs included behavior-related events, organizational or infrastructure issues, and medication errors. No data on serious adverse events, discontinuations, or tolerability were reported. A significant variability in reporting was observed across different provinces. The study does not establish causality, and the hypothesis that primary risks are mainly driven by relational dynamics remains unproven. Practice relevance highlights the need for inclusive safety interventions and training focused on relational risk management, de-escalation, and empathic communication for all workers.
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