Patient Safety First

More than 40 psychiatric patients per year die of “unexplained” causes

More than 40 psychiatric patients per year are dieing of “unexplained” causes while on mental health in-patient wards.

Heart failure from antipsychotic drugs, the use of physical restraint, “physiological arousal” from a patient’s mental illness, and underlying heart disease are likely to the cause of such deaths, states a new report.

The report, commissioned by the National Patient Safety Agency, was carried out by the government’s national inquiry into suicide and homicide by people with mental illness.

There were 235 “sudden unexplained deaths” on mental health in-patient units in England and Wales between 1999 and 2004. This is 41 cases per year.

The report’s authors recommend a “cautious” approach to prescribing of antipsychotic drugs, better monitoring of patients with heart and breathing problems and that physical restraint be used as a last resort and according to official standards.

The report, entitled Avoidable Deaths, also stated around 50 homicides are committed each year in England and Wales by mental health patients. This is 9% of total homicides.

But the number of homicides by the mentally ill is not increasing, and the risk of “random” killings by such people has not risen in the last 30 years, emphasised the authors.

Of the total 600 average homicides per year in England and Wales, the inquiry found 30 (5%) were committed by people diagnosed with schizophrenia.

“Community care has not increased the risk to the general public,” stated the report.

But the report, published this month, emphasised that many psychiatric patient suicides – around 1,300 per year – and homicides by people diagnosed with a mental illness were preventable.

Researchers found that in the week prior to suicide, 49% patients were seen by mental health services. But staff judged only 14% to be at risk of suicide.

And in the week prior to homicide 29% patients were seen by services. But staff judged only 9% of these to be of moderate or high risk of violence.

Prof Louis Appleby, the national director of mental health, said staff – such as psychiatrists and nurses – are wrong to believe many patient deaths or homicides are inevitable.

He said: “It is time to change the widespread view that individual deaths are inevitable – such a view is bound to discourage staff from taking steps to improve safety.”

Prof Appleby was also quoted in one newspaper as saying that mental health professionals are becoming “desensitised” to the violence or suicide risk of some patients.

The report was published as the government tries to extend compulsory powers of detention and treatment over some psychiatric patients.

But campaigners opposing planned new law say the Avoidable Deaths report revealed no need for further compulsion powers.

Andy Bell, chair of the Mental Health Alliance, a coalition of 78 mental health, carer and law organisations, said: “There is no lack of compulsion in current legislation. Mental health law is one of the most powerful legal tools there is – people can already be detained, and treated against their will if necessary, if doctors suspect there is any danger.

“The myth is that the move to community-based care is behind these incidents, but that is absolutely not the case.

“The number of homicides by people with mental health problems has not changed since the 1950s and the days of asylums, even as the overall murder rate has increased.” significantly.”

Leave a Reply