Mny 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.
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.
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.
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.
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.
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.
Mental Health Campaigners minimising the problem (amongst others) “The degree to which the [danger posed by mental health patients] has been overstated is considerable.” Andy Bell, Mental Health Alliance, Independent – 10 December 2006 “Focusing on homicides is a mistake. They are freak events” Tom Fahy, Professor of forensic mental health, Institute of Psychiatry. Mental Health Today November 2006 page 8 ‘Time to Change’ Summer advertising campaign;
Paul Farmer, Chief Executive Mind (BBC News 28 July 2009);
Royal College of Psychiatrists, Changing Minds campaign –
page taken down after intervention by hundredfamilies.org
Prof George Szmukler, Institute of Psychiatry.
- NOT INVESTIGATING PROPERLY
The Chief Executive of the NHS had to remind Strategic Health Authorities of their obligations to commission homicide inquiries after it emerged many weren’t bothering
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Independent Homicide Investigations. April 2008 found 30% of homicides by the most seriously ill mentally ill people who were under an enhanced programme of care did not receive a full independent investigation as they should have done. (p3)
- NOT LEARNING LESSONS
In 2008, the Healthcare Commission published ‘Learning from Investigations’. It found that despite the high number of investigations into mental health services: “A common theme in these referrals is a failure by trusts to learn from serious untoward incidents”
National Confidential Inquiry into Suicide and Homicide by people with mental Illness. Independent Homicide Investigations. April 2008 http://www.medicine.manchester.ac.uk/psychiatry/research/suicide/prevention/nci/reports/HomicideInvestigationsReportApr2008.pdf
M McGrath & F Oyebode. Qualitative Analysis of Recommendations in 79 Inquiries after Homicide Committed by Persons with Mental Illness.
Journal of Mental Health Law, December 2002, p262 -282
M Howlett, Victims and Survivors in: Mercer et al. Forensic mental health care. A case study approach (2000);
C Parker & A McCulloch. Key Issues from Homicide Inquiries, MIND, London, May 1999
Richard Lingham. Echoing Blunders, Sanetalk, Spring 1997;
David Shepherd. Learning the Lessons, Zito Trust, London 1996;
C Kaye and M Howlett. Mental health in the slow lane. Health Service Journal, 5 Nov 2008
Personal knowledge and communication with the families of Ben Cargill, Tom Easton and Colin Johnson.
Case of John Bryceland who murdered his partner Jacqueline Hughes, Glasgow Aug 2007.(She pleaded to section him, MH services said they couldn’t discuss it with her, he killed her days later).
NHS West Midlands: Report of the Independent Inquiry into the care and treatment of Mr Glaister Earle Butler, (2009)
Glaister Butler report recently unavailable on the above link but is available here 5.2MbKiller’s consent from:
NHS National Patient Safety Agency. Independent investigation of serious patient safety incidents in mental health services. Good practice guidance. (Feb 2008) p 13 & 35
- SYMPTOMS NOT CAUSES
Interviews with Consultant Psychiatrists:
Dr Paul McMullen, Dr Trevor Turner, Dr David James and Dr Tony Maden
- I’M NOT ILL
Avon and Wiltshire Mental Health Partnership NHS Trust. Root Cause Analysis Report. Fatal Stabbing of PH [Philip Hendy] by SN [Stephen Newton] 29 April 2007; Sept 2007 R V Newton Trial transcript – Bristol Crown Court October 2008.
Report to the North East Strategic Health Authority of the Independent Inquiry into the Health care and Treatment of Garry Taylor, October 2007.
E Fuller Torrey. The Insanity Offence. New York & London 2008,
Chapter 7 – ‘God does not take medication’ p 111
NHS London/Caring Solutions Report ‘Learning from Experience’
April 2008, p 56 (LINK)