Mental health: Safeguarding & fitness to practice - Hamilton Fraser


In this special feature for World Mental Health Day, Kimberley Cairns breaks down how safeguarding and fitness to practise could provide a unique opportunity to provide a collective and shared moral responsibility making ‘mental health a global priority’.


Mental health continues to dominate headlines. In July 2022, MPs on the Health and Social Care Committee reported their findings into the impact of poor body image on physical and psychological health outcomes. This could be considered a catalyst for the permanent grounding of psychology in the sector, providing a comprehensive and revealing insight into detailed psychological vulnerabilities, complexities and explicit experiences and influences that negatively affect health outcomes, including aesthetic consumers. Practitioners must ‘tune in’ to subtle language and behaviour changes and make sure they have a good understanding of current and emerging psycho-social factors affecting the dynamic aesthetic consumer and how this may implicate risk taking behaviours.

Safeguarding: Expect the unexpected  

Safeguarding involves protecting a person's health, wellbeing and rights to enable life free from harm, abuse and neglect. This is all encompassing and examples include financial, physical, psychological, sexual, self neglect, modern slavery, domestic and or exploitation.

As an aesthetic practitioner, you may come into contact with vulnerable adults who are at risk of harm, abuse or mistreatment. You may hear or see past suffering, early signs or witness an event that indicates real time mistreatment or suspect future endangerment. This includes concerns about the treatment of a patient from another aesthetic practitioner. Safeguarding is an integral part of providing high-quality care and you must be suitably prepared for this.  

The Health and Social Care Committee recommended that within the scope of licensing, a practitioner should be required to conduct a full physical and mental health assessment. Therefore it is essential to be better prepared and equipped to support vulnerable adults at any time during the patient journey.  Read Hamilton Fraser's separate guide on the Health and Care Act 2022 for more information.

Reports of distressed patients presenting at consultation and post treatment are increasing. This is having serious implications for practitioners and how they approach mental health and apply safeguarding in practice. The pressurised NHS, lack of body image education, toxic social pressures, peer relationships, cultural conformity to beauty standards, and the ‘weaponising’ of mental health could all provide detailed explanations here. However, this debate stretches far beyond the intentions of this blog.  

Fitness to practise: What to look out for

It is widely agreed that to practise safely, you must be competent in what you do. Fitness to practise is as much about character, and health as it is about meeting professional standards. Safeguarding patients provides a unique opportunity to reflect on fitness to practise and unite the sector as guardians of aesthetics. This is essential for public protection, and to boost public confidence in the aesthetic profession.

Establishing and maintaining effective therapeutic relationships can be challenging and directly affected by practitioner wellbeing. Common working practices in the sector put the sector at risk of many unique factors that can be particularly challenging to address and manage if not appropriately supported (e.g 1-2-1 working).

It is well reported that across the UK, mental health continues to deteriorate at an alarming rate, with rising mood disturbance, eating dysfunction, and sleep disturbance. The Safety in Beauty Survey (2022) revealed that seven out of 10 professionals running a business in beauty or aesthetics admitted being overwhelmed ‘most days’, and as a result self-reported that they are ‘currently suffering a mental health issue’. This included anxiety, panic, depression, body image related issues, obsessive thoughts and compulsive behaviours as well as drug or alcohol dependency. Learning of these findings is alarming, which begs the question; If you or a colleague experiences ill-health, capacity slumps and performance suffers, how likely are you to safeguard? Do your thoughts around this change if this is a physical health issue or a psychological health concern? What, if anything, can you do to approach concerns for a patient, and concerns for a practitioner?

Individual action for cultural change

The majority of aesthetic and non surgical cosmetic treatments are sold as a gateway to elevated wellbeing or as an attribution of self care. However, evidence is showing that aesthetic experiences can result in many long term psychological dissatisfactions, and even patient casualties. Practitioners are also facing devastating health consequences including suicidal ideation when treatments don’t go to plan. Safeguarding unintended patient dissatisfaction and unwanted treatment outcomes must be everybody's business.

● Prevention: Anyone with concerns should not be silenced. An ethical clinic culture is safe for anyone to come forward and report serious incidents and safeguarding concerns. This must be met with assurance of a sensitive and proper manner. Mitigate risk through robust HR policies, CQC registration and DBS checks at recruitment. Build a trusted multi-disciplinary team with a network of professionals where you can access and engage in regular confidential peer to peer, group and/or 1-1 supervision to discuss any safeguarding issues

● Paramountcy: Safeguarding concerns must be dealt with promptly and must take precedence over any other matter at the material time. Make full notes of your decision, actions and reasons and keep this strictly confidential. Ongoing support for staff and training is fundamental and you must keep up to date with statutory regulation in your part of the UK

● Proportionality: Take an individualised proportionate action by taking the least intrusive response most appropriate to the risk presented. It is essential to engage in ‘self’ and ‘other’ monitoring to maintain healthy personal functioning and professional accountability. Should a practitioner feel they are unable to work, seek advice from a trusted colleague, supervisor or health professional, limit services, or perhaps withdraw for a period for necessary rest and recovery

● Empowerment:  Make clear from the outset of the professional relationship the limitations of confidential practice (promises can never be made and secrets never kept). Share the measures that are in place, what may trigger them, what will happen and why they are there. This can ensure people are supported and confident in making their own informed decisions for choice and control

● Partnership: Contact your local authority who operate within the legal framework for safeguarding provisions and they will provide you with details of your local safeguarding officer. Anyone with a concern should be encouraged to make contact

● Protection: Talk to your local safeguarding officer if a significant issue arises or if you are unsure about the information/evidence you have. Your local safeguarding officer will be able to support you and talk through any concerns

● Accountability: Sharing safeguarding concerns is not about making the final decision on how best to protect. Accountability must always uphold the best interests of members of the public and to seek to protect vulnerable members of society. Be aware of your professional duty and compliance with the organisation(s) of which you/they may belong to


The unintended psychological consequences of poor patient selection and treatment outcomes can implicate both safeguarding and fitness to practise. Despite some visible progress in the sector, people with mental health conditions can still experience discrimination, stigma and even severe human right violations. The reality is what may seem like a difficult conversation, may save a life, end harm and create a safer sector.

For related content read Kimberley's blogs on the importance of psychology in aesthetic licensing and ADHD in aesthetics, which offers guidance for practitioners treating patients with ADHD.

About the author

Kimberley Cairns

Kimberley Cairns

Kimberley is an award winning, dynamic, inclusive published wellness expert and member of the British Psychological Society. Her innovative integrated psychological approach to aesthetics encompasses her combined 16 years of acute mental health and aesthetic clinic management experience. Specialising in psycho-aesthetic solutions, Kimberley has numerous key appointments including that of clinical advisory and fitness to practise within the JCCP and more recently as a board member. Her contributions to aesthetics in the interest of public health protection and the promotion of patient safety are extensive.

Get a quote today!
We’ve made the process easy