Accountability in acute in-patient mental healthcare: advancing structural and cultural change

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Sustained improvement in acute in-patient mental healthcare accountability requires structural and cultural alignment, with the strongest current evidence supporting strategies that reduce coercion and utilize measurement systems. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Corrado Barbui; Charlene Sunkel; Graham Thornicroft

doi:10.1192/bjp.2026.10769

September 1, 2026The British Journal of PsychiatryOpen Access

Accountability in acute in-patient mental healthcare: advancing structural and cultural change

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Key Points

To examine accountability in acute inpatient mental healthcare through answerability, responsibility, and responsiveness, and to evaluate key strategies for systemic reform.
Narrative review synthesizing governance models, safety failures, and accountability mechanisms across acute inpatient psychiatric settings.
Evaluation of evidence-based interventions targeting oversight, practice standards, and institutional culture.
Interventions focused on reducing coercion and establishing structured clinical measurement systems demonstrate the strongest empirical support.
Sustainable reform requires simultaneous alignment between structural governance frameworks and underlying ward-level organizational culture.

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Implication

Review reveals accountability strategies improve safety in acute inpatient psychiatric care, highlighting the necessity of structural and cultural alignment.

Abstract

Following safety failures and gaps in oversight, acute in-patient mental health services face increasing scrutiny. This article examines accountability, conceptualised as answerability, responsibility and responsiveness, and reviews key strategies. Evidence varies in strength, with strongest support for reducing coercion and measurement systems. Structural and cultural alignment is essential for sustained improvement.

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Barbui et al. (2026) studied this question.

synapsesocial.com/papers/6a9935c7636c6408cfa7e34b https://doi.org/10.1192/bjp.2026.10769

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Accountability in acute in-patient mental healthcare: advancing structural and cultural change

Key Points

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Implication

Abstract

Discussion

Cite This Study

Accountability in acute in-patient mental healthcare: advancing structural and cultural change

Key Points

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Implication

Abstract

Discussion

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