Developing the Allied Health Professionals workforce within mental health, learning disability, and autism inpatient services: Rapid review of learning from quality and safety incidents.

Background: Allied health professionals (AHPs) in inpatient mental health, learning disability and autism services work in cultures dominated by other professions who often poorly understand their roles. Furthermore, identified learning from safety incidents often lacks focus on AHPs and research is needed to understand how AHPs contribute to safe care in these services. Methods: A rapid literature review of material published 02/2014-02/2024 reporting on safety incidents within adult inpatient mental health, learning disability and autism services in England, with identifiable learning for AHPs, was conducted. 115 reports/publications were included, predominantly comprising NHS England independent investigation, prevent future deaths, and Care Quality Commission reports. Findings: Misunderstanding of AHP roles, from senior leadership to frontline staff, led to AHPs being disempowered and excluded from conversations/decisions, and patients not getting sufficient access to AHPs, contributing to safety incidents. A central thread ‘organisational culture’ ran through five subthemes. 1) (lack of) effective multidisciplinary team (MDT) working with examples of poor communication, silo-working, marginalisation of AHPs, and a lack of psychological safety. 2) (Lack of) AHP involvement in patient care including care and discharge planning, and risk assessment/management. Some MDTs had no AHPs, some recommendations by AHPs were not actioned, and referrals to AHPs were not always made when indicated. 3) Training needs were identified for AHPs and other professions. 4) Staffing issues included understaffing of AHPs. 5) Senior management and leadership were found to not value/understand AHP roles, and instil a blame culture. A need for cohesive, well-led and nurturing MDTs was emphasised. Conclusion: Understanding and recognition of AHP roles is lacking at all levels of healthcare organisations. AHPs can be marginalised in MDTs, presenting risks to patients and missed opportunities for quality improvement. Raising awareness of the essential roles of AHPs is critical for improving quality and safety in inpatient mental health, learning disability and autism services.