Harm from ineffective risk management	Harm from inadequate or unsuccessful prevention and management of risk, such as self‐harm, suicide or risks of violence and aggression. Capacity for prevention of these events by services may not always be clear.
Harm due to failure to provide appropriate treatment	Service users routinely do not receive optimal or evidence‐based standards of care, which may contribute to harm. For example, staffing shortages may result in service users not being assigned a care coordinator when one is required, or not receiving care within safe timeframes.
Medication‐related harm	Medications prescribed for mental health problems may result in adverse drug reactions, unpleasant or harmful side‐effects, or contribute to the development of comorbid physical health conditions. Medication errors, on part of care teams or service users and their carers, may also result in harm. This is increasingly relevant in community care, where service users play a larger role in their own medication management.
Harm from restrictive or coercive care	Harm may stem from the use of restrictive practices in mental health care, including scenarios where there is contact with other services which are less equipped to address a mental health crisis (e.g., the police). Service users may feel that they have little control over their own lives.
Harm due to undertreatment	Avoidable harm may result from under‐detection and undertreatment of risks associated with prescribed medications, such as failure to prescribe metformin for antipsychotic‐induced dyslipidaemia. Similarly, access to interventions, such as psychological therapies, amongst service users who would benefit from such treatment may be inequitable and more readily offered to those perceived to be assertive or articulate.
Harm relating to diagnosis	Misdiagnosis, missed diagnosis or delayed diagnosis can cause harm by delaying access to the appropriate course of treatment. Delays may contribute to deterioration and loss of confidence in mental health services. Service users may also experience harm associated with the specifics of the diagnosis they receive. For example, those with a personality disorder diagnosis may be faced with lack of adequate treatment pathways or stigma from care teams.
Psychological harm	Unhelpful or distressing encounters with community‐based mental health services may cause service users to feel unsafe when using these services. Similarly, prior experiences of compulsory treatment under Mental Health Act legislation may erode trust in care systems, potentially leading service users to conceal important risk information from care teams.