Why Does It Keep Happening?

Many studies show mentally ill people who kill were not getting the care and treatment they needed.

• Many Mental Health Services are in denial about violence
• They are failing to investigate properly
• They are failing to learn lessons
• They have a culture of secrecy
• They treat symptoms not causes
• Psychotic patients often don’t think they’re ill

Mental health services are in denial about violence
For many mental health practitioners and campaigners violence is a taboo subject. Some deny it even exists. They do so out of an understandable but misguided fear of ‘stigmatising’ the mentally ill. Actual levels of violence are minimised or explained away – which leaves services unprepared and surprised when violence does actually occur. This denial also means health authorities are often reluctant to investigate homicides as fully and as quickly as they should.[1]

Mental health services are failing to investigate properly
A review of many mental health homicide investigations reveals many mental health trusts are failing to investigate such cases properly. Some refuse to commission independent inquiries despite a clear requirement by the Department of Health to do so. Some rely instead on the internal reports of the mental health trusts who are effectively investigating themselves. If they do commission inquiries, there is often no member of the panel that doesn’t have a connection to mental health services in some form. They are invariably delayed in starting, fail to engage the victims’ families as they should, and are shrouded in such secrecy as to prevent effective public scrutiny. There is currently no effective oversight to make sure Strategic Health Authorities and Mental Health Trusts are carrying out their obligations as they should.[2]

Mental health services are not learning lessons
Analyses of many mental health homicide inquiries since 1993 show the same problems keep occurring. Typically these include a failure to keep proper records; failure to plan care properly; failure to do adequate risk assessments; failure to treat drug problems; failure to listen to families & carers; failure to follow up missed appointments; failure to ensure medication is taken; and a failure to assertively treat deteriorating patients. These same problems crop up again and again in independent investigations. They have also become the subject of official national and professional guidance. Recommendations for change appear to be routinely ignored without sanction. Despite all the action plans and new policy initiatives there is little evidence that lessons are being effectively learned because the number of mental health homicides continues to rise.[3]

Mental health services have a culture of secrecy
Many mental health professionals appear reluctant to share patient information with other agencies out of a misplaced fear of breaching ‘patient confidentiality’. This overriding concern for the rights of the patient over public safety can have terrible consequences. Patient confidentiality has now become so pervasive that independent inquiries even have to request consent from the killer before they can start to investigate the case.[4]

Treating symptoms not causes
Many seriously ill psychotic patients are admitted to hospital when they are in crisis, only to be released days or weeks later when medication has stabilised their condition. Little attention is given to their long term problems – most commonly treating their drug abuse effectively. It makes little sense for a drug abusing psychotic patient to have a series of short term admissions only to be released back to an environment where street drugs are readily available at the first hint of difficulty.[5]

Seriously ill psychotic patients often don’t realise they are ill
Seriously psychotic patients often have little insight into their condition and don’t believe they are ill. They will stop taking their medication and not comply with treatment because they believe they don’t need it. The current culture of ‘service user centrality’ is entirely focussed on the patient deciding when and what treatment they will receive. This is fine for people with insight who want to get better but can be catastrophic for seriously ill people who don’t even realise they are ill.[6]

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