Who Does What?

  • Mental Health Trusts and Strategic Health Authorities
  • Official investigations by health trusts and authorities
  • Health bodies in Scotland, Wales and Northern Ireland

Mental Health Trusts are local NHS organisations responsible for providing specialist care and treatment for people with mental health problems that can’t be treated by the GP alone.

This care is delivered both in hospitals and by community mental health teams.

There are currently 73 mental health trusts across England.

A list of them is here:

Mental Health Trusts are supervised by Strategic Health Authorities (SHAs) which are regional NHS management bodies.

Part of their job is to make sure local mental health services are of a high quality and are performing well.

There are ten SHAs in England.

A useful site listing them and the local health trusts they cover is here: http://www.housing.nhs.uk/SHAList.aspx

Official investigations by health trusts and authorities

If a recent mental health patient commits murder or manslaughter, then the government requires the local Strategic Health Authority to hold a full independent inquiry to see if any lessons can be learned.

There is detailed official Department of Health guidance on how and when these inquiries should take place. [1][2][3][4]

Officially, health bodies do not have a choice. They have to do them, and they have to do them well and promptly and they have to act effectively on any findings or recommendations.

In practice, however, it’s often a very different story.

See Homicide Inquiries.


Mental Health services in Scotland are delivered by 14 regional NHS boards. A list of them is here:

Inquiries into mental health homicides in Scotland are undertaken by the Mental Welfare Commission for Scotland. Inquiries are held when the MWCS become aware of a serious case for investigation or at the request of the Scottish government.


Mental health services in Wales are provided by seven regional health boards

North Wales – The Betsi Cadwaladr University Health Board http://www.bcu.wales.nhs.uk/

West Wales – Hywel Dda Local Health Board http://www.hywelddalhb.wales.nhs.uk/

Powys teaching health board http://www.powysthb.wales.nhs.uk/

Gwent – Aneurin Bevan health board, http://www.wales.nhs.uk/sitesplus/866//

Merthyr and Rhonnda – Cwmtaf health board http://www.cwmtafhb.wales.nhs.uk

Cardiff & Vale University Health Board http://www.wales.nhs.uk/sitesplus/864/

Swansea & Neath, Port Talbot, Bridgend

Abertawe Bro Morgannwg University Health Board http://www.wales.nhs.uk/sitesplus/863/page/40845

Inquiries into mental health homicides are undertaken on a case by case basis by Healthcare Inspectorate Wales.



Mental Health Services in Northern Ireland are provided by five regional Health and Social Care Trusts. A list of them is here.

There is separate guidance issued by the Northern Ireland Department of Health Social Services and Public Safety about inquiries following mental health homicides. It is broadly similar to the guidance in England.[5]

Homicide Inquiries are commissioned by the local Health and Social Care Trust.


  1. Official Department of Health Guidance requiring independent inquiries after a homicide by a recent mental health patient was first issued in 1994 http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Healthserviceguidelines/DH_4104914


  2. The advice was updated in 2005, with some extra conditions in 2006. 2005 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4113574.pdf 2006 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_063043.pdf

  3. back

  4. Because some Health Authorities were not fulfilling their obligations the advice was restated again in 2007. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_076537.pdf


  5. In 2008, the National Patient Safety Agency set out Best Practice guidelines for how these investigations should be carried out. http://www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=60156&type=full&servicetype=Attachment


  6. Northern Ireland GuidanceGuidance on Discharge from Hospital and the Continuing Care in the Community of People with a Mental Disorder who could Represent a Risk of Serious Physical Harm to Themselves or Others, 2004. (Section 14) http://www.dhsspsni.gov.uk/discharge-guidance-2004.pdf

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.