Are Mental Health Services Accountable?

According to the NHS Constitution when things go wrong the responsible NHS organisation should acknowledge the fact, apologise, explain what went wrong and put things right quickly and effectively.

But in Mental Health Services it rarely seems to work out like that.

Some homicide inquiries, (generally the less independent ones), will document a whole series of serious failings yet still conclude the killing wasn’t predictable or preventable.

Nobody is ever responsible or held to account for the failings.

A Freedom of Information request to the General Medical Council – the doctor’s watchdog – revealed that despite hundreds of mental health homicides since 1993, not one psychiatrist has ever been disciplined by them following a homicide by a mentally ill patient.

Inquiry reports go out of their way to avoid a ‘blame culture’; which means incompetence, neglect, and grossly inadequate performance is routinely tolerated without any sanction whatsoever.

The frequent use of anonymity and claims of patient confidentiality mean many inquiries operate under a suffocating blanket of secrecy, which frustrates transparency, openness or any form of adequate public scrutiny. (See Case History – Leon Hutchinson)

And because many inquiries are delayed and only appear many years after the original killing, health authorities can claim everything has changed in the mean-time, action plans and targets have been drawn up (on paper), the same staff are no longer involved in delivering services, and that the public has nothing to worry about.

Typically, they’ll trot out the old lie “lessons have been learned”, which might offer a comforting sound bite for the press, but will carry little weight with the families of the next victims.

If lessons had indeed been learned, homicides by the mentally ill ought to be going down.

They aren’t – they are rising steadily.

This refusal to be properly open and accountable is not without consequences.

Lack of accountability arguably

  • has a highly negative effect on public attitudes to mental health service managers and professionals.
  • will encourage those who claim mental health services are negligent in protecting their patients and the public, and
  • will inevitably increase stigma towards the mentally ill


Department of Health. The NHS Constitution for England. 2009.

Inquiries which list significant failings yet find the murder neither predictable nor preventable include Robert Browning, Leon Hutchinson, Benjamin Holiday & Aisling Murray

General Medical Council. Freedom of Information Request Ref: IAT/F08/1950/EH, December 2008, January 2009

For rising Homicides (see Numbers) and National Confidential Inquiry into Suicide and Homicide by People with Mental Illness – Annual Report: England & Wales, July 2009. Table 8 – page 33