While overall incident reporting in mental health settings has increased in recent years, so too has the frequency of self-harm and aggression towards patients and staff, which continue to be leading causes of adverse incidents. However, unlike adverse incident reporting in general hospitals, which focuses on factors such as suboptimal treatment or care, adverse incidents in mental health still focus on patients and their acts of self-harm or perceived aggression. Mental health adverse incident policy needs to change to emphasise that incidents occur when staff are unable to provide appropriate care, rather than simply when a patient becomes aggressive or engages in self-harm. However, this requires a shift in the values used to monitor adverse incidents so that patients’ self-harm or aggression is regarded partly as an outcome of inappropriate or omitted care, rather than solely a result of the patient’s actions.