Metal Health under the magnifying glass

Methods of assessing risk of psychiatric patient violence to be scrutinised

Procedures used by mental health professionals to assess the risk of patient violence are to be scrutinised as part of a programme to reduce the number of suicides and homicides by people with mental health problems.

The Department of Health is to launch a “risk management programme” in a bid to improve how psychiatrists, nurses and other professionals assess the risk of patients becoming violent or suicidal.

The government says between 55 and 60 homicides are committed by mental health patients per year, and around 1,000 people who have used mental health services commit suicide per year.

The government said last week it wants to develop a “national evidence framework” for assessing and managing risk and to develop guidance on information sharing between agencies about high-risk patients.

In a related measure, the government is to review the care programme approach (CPA) used by professionals to assess, plan, coordinate and review care of patients.

This review will aim to look at ways to reform the “cumbersome” and “bureaucratic” care planning process, and give patients more control over their care and choice of treatment. Proposals include strengthening the role of the care coordinator and improving information sharing between health, social care and criminal justice agencies.

Mental Health Minister Rosie Winterton said: “We need to be better at spotting the signs of danger, we need to improve the way agencies work together and we need to provide care that will help patients recover and regain their independence.”

Ms Winterton also emphasised that she plans to go ahead with supervised “community treatment orders” (CTOs). Plans for CTOs are to be included in a “streamlined” mental health bill. CTOs, already active in Scotland, aim to ensure that patients discharged from compulsory treatment in hospital continue to comply with treatment.

The Sainsbury Centre for Mental Health has different homicide figures to the government. It has previously stated that between 30 and 50 killings each year out of 800 are by people who are in contact with mental health services. And critics are accusing the government of failing to recognise that this “tiny” percentage of all homicides committed by people with mental health problems has not increased in the last 30 years.

They argue that making sure patients receive care and treatment when they request it will reduce violent or suicidal incidents more than increasing compulsory treatment

Mental health charity Mind’s chief executive, Paul Farmer, welcomed the reform of the CPA. He said that ” giving service users choice over their own care is crucial to wellbeing and recovery.”

But he added that the government should be focusing on giving people “the right to help”.

“It is too often the case with the rare homicides committed by people with mental health problems that services have failed to engage with people who are actually going and asking them for help, let alone put together a care plan with them,” he said.

“Mind urges the government to review its approach to amending mental health legislation to ensure that the law empowers people by giving them the right to help when they ask for it. This is the best way to reduce the risk of tragic incidents occurring.

“Compulsory treatment cannot make any difference here, when the problem is not that people are refusing treatment, but that they are not being given treatment when they seek it.”

Kathryn Hill, director of mental health programmes with the Mental Health Foundation charity, said: “Despite what society is led to believe people with mental health problems actually pose very little danger to the public…Drugs and alcohol are a much bigger factor in homicides than mental illness.”

She added that people with mental health problems are more often the victims of violent crime and abuse both on the street and in inpatient settings. A National Patient Safety Agency report, published in July, revealed that from November 2003 to September 2005, there were 44,000 reported harmful incidents inside mental health settings, including 19 alleged rapes of patients. Most incidents were in inpatient settings.

The government’s measures are based on recommendations contained in an independent review of homicides by people diagnosed with a severe mental illness. It was carried out by Professor Tony Maden of Imperial College London.

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