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Several examples of 'active failures' were also described. DISCUSSION AND CONCLUSIONS Safety issues appear broader than those recorded and reported by health services and inspectorates. Many safety issues have also been identified in other care settings supporting the notion that there are overlaps between service users and carers' perspectives of safety in mental health services and those of users in other settings. Areas for further research are suggested. © 2020 The Authors Health Expectations published by John Wiley Sons Ltd.