When Care Becomes Harm: Sexual Exploitation, Abuse and Harassment in Mental Health Care: Advancing a Mental Health Safeguarding Framework from Kenya to Global Practice
DOI:
https://doi.org/10.70619/vol6iss6pp57-79-943Keywords:
Mental health safeguarding, Sexual exploitation, Sexual abuse, Sexual harassment, Professional ethics, Therapeutic relationships, Human rights, Kenya.Abstract
Background: Sexual exploitation, abuse, and harassment (SEA/SH) constitute serious violations of professional ethics, patient safety, and human rights. Although safeguarding has become integral to healthcare, humanitarian, and education sectors, its application within mental health care remains underdeveloped despite the unique relational and ethical dynamics of therapeutic practice.
Objective: This review advances Mental Health Safeguarding as an emerging interdisciplinary field and proposes the Mental Health SEA/SH Safeguarding Framework (MHSSF) to strengthen prevention, early identification, response, accountability, and organisational learning. Using Kenya as a contextual lens, the paper demonstrates how safeguarding principles can be operationalized within mental health systems while generating globally applicable insights.
Methods: A critical narrative review was conducted using multidisciplinary literature from mental health, safeguarding, professional ethics, gender-based violence, human rights, organisational governance, and implementation science. Evidence was synthesised through thematic analysis and conceptual integration to develop an evidence-informed safeguarding framework.
Results: Existing literature largely addresses professional boundaries, workplace harassment, ethics, and patient safety separately, leaving safeguarding within mental health conceptually fragmented. The review introduces four interrelated concepts, Dynamic Vulnerability, Therapeutic Power Asymmetry, Boundary Erosion, and Organisational Safeguarding Capacity, which are integrated into the MHSSF. The framework provides a systems-based approach for strengthening safeguarding across governance, policy, professional education, clinical practice, regulation, and organisational leadership.
Conclusion: Safeguarding should be recognised as a core dimension of quality mental health care rather than merely a response to professional misconduct. The MHSSF provides a conceptual foundation for strengthening trauma-informed, rights-based, and accountable mental health systems while supporting future research, policy development, and implementation across diverse settings.
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