How Can Families be Involved?

  • Good theory – What should happen
  • Bad practice – What actually happens
  • What can families do?

Good Theory

Current government guidance says the mental health trust and the Strategic Health Authority (SHA) should involve families in the investigation process and kept them fully informed if they so wish.

In theory

  • within the first three days of the incident, mental health trusts and SHAs should be planning how they are going to contact the victim’s family and who will be their contact person (on page 7 of the NPSA guidance)
  • families should be kept informed and involved during the Internal Investigation – so that any concerns they have can be looked into (page 9, 10)
  • families should have the opportunity to meet senior members of the Trust to discuss how they will be involved in the process (page 10)
  • the findings of the Internal Investigation and the actions to be taken should be discussed with families (page 10)
  • the Internal Investigation report should usually be shared with them (page 11)
  • families should be informed about any external Independent Inquiry and told how they can be involved (page 13)
  • they should be offered a meeting with the Inquiry panel (page 15)
  • they should have adequate time to see the final copy of the inquiry report before it’s published (page 15)

The official guidance says any communication by health bodies with the families of victims should be held in the spirit of “honesty and openness”. The investigation processes should be “transparent, open, inclusive, timely and proportionate.”
The rest of this section is worth quoting in full:

The basic principles [for Health authorities] underlying this communication are the:

  • principle of acknowledgement;
  • principle of truthfulness, timeliness and clarity of communication;
  • principle of apology.

When an incident leading to serious harm or death occurs, the needs of those affected should be of primary concern to the trust, the SHA and those undertaking any investigation.
Any contact should be undertaken in a respectful, dignified and compassionate manner, and in a spirit of openness.
A designated, senior individual, with the appropriate skills and experience, at the trust (in the most serious incident, for example homicides, likely to be at board level) should take the lead, and agree with the family who the main family contact will be.
Victims and families want to know:

  • What happened?
  • Why it happened?
  • How it happened?
  • What can be done to stop it from happening again to anyone else? “

(from page 19 of the NPSA guidance)

Bad Practice

But whilst the theory sounds great on paper, the reality is often completely different.

In nearly three years of research, looking at hundreds of cases and talking to victims families, there has never been a single case where this system of open, honest and timely communication has worked as it should have done, as laid out in the official guidance.

All the families contacted for this research without exception, had found it extremely difficult to get any information from the mental health trust or SHA involved.
Often it would take repeated requests from the family to get any response. And if a response did come it would often be partial and unhelpful.

If victims’ families are denied access to information about the case, they are left just with rumour, speculation and their own imagination about what happened – which is deeply unsettling and can only add to their distress.

Only when a thorough Independent Inquiry was published did some families (not all) start to get some of the information and answers they were looking for.
And those were often the inquiries that took their job seriously and which were truly independent.

So what can families do if they have concerns, or want to be better involved in the investigation process?

  • Write to the Chief Executive of the Mental Health Trust.
  • Write to the Chief Executive of the Strategic Health Authority.

(For contacts see Who Does What page or Further Help page)

Families could ask

  • if the case is being investigated
  • if the perpetrator was a recent patient of the mental health trust
  • how the trust is planning to keep the victim’s family involved
  • who the contact person will be.

You might want to quote from the NPSA Good practice guidance above and ask them how they are meeting their responsibilities.

You should keep copies of any letters, and ideally make a note of any phone conversations you have with the Health Authorities.

Letters from the victims’ families should bring an urgent response from the health authorities.

If not, you might want to think about contacting the local press to tell them of your difficulties.

They are bound to be interested.


NHS National Patient Safety Agency. Independent investigation of serious patient safety incidents in mental health services. Good practice guidance. (February 2008)

NHS National Patient Safety Agency. Being Open, Communicating Patient safety incidents with patients, their families and carers (2009)

2 Replies to “How Can Families be Involved?”

  1. I sent this letter published in the BJ psychiatry. If all mental health teams follow the practice it would make a huge difference Perhaps ought to ask the trusts whether they have this working practice for their teams
    Inquiries after Homicide
    David H Yates, retired psychiatrist Royal College of Psyciatrists
    Comments made by carers, after an Inquiry a homicide where the perpetrator was a patient receiving NHS mental healthcare provision, express their concerns that their observations about perpetrator behaviour did not receive a proper attention by the teams delivering that care.
    Many previousInquiry Reports following a homicide committed by patients receiving NHS mental care provision, list this failing to receive or act upon information in observations from carers involved in that care.
    A simple directive to mental health teams would bring an end to this kind of disaster.
    In the response from a second Internal Inquiry to such an event in Cornwall, an accepted recommendation for avoiding such a disregard for carer observations, by the Trust was that the
    weekly meetings of all mental health teams should follow an agreed agenda
    that would record those present and the outcomes expected from any deliberative decisions.
    The localTrust carer sub-committee added to this agenda, that ‘any Carer Issues’ would be an item in the agenda.of the weekly team meetings
    Adopted by all Mental Health Trusts, this practice would be a sufficient reminder that carers who express risk concerns should not be ignored or disregarded in any future similar situations
    yours ssincerely
    David H Yates. FRC Psych
    { Wintergreen ,St jidgey, Wadebridge. Cornwall PL27 7RE
    01208 816035

    1. This is a simple effective step that can be done .
      I remember collating a copious number of inquiry into homicide reports for my dissertation at university with my dad . This was in 1997 but I remember being taken aback by the surge in number over the period I was researching this. At that point they were in double figures.
      Even as an undergraduate researcher it was not complex to notice and therefore very clear that carer communication/ engagement or rather lack of it was a recurring factor.
      I cannot see why there is any valid reason not to implement this action, based on the factual evidence available on failed carer engagement / communication in past cases ?
      Can anyone explain why there is s valid reason not to?
      With kind regard, as ever
      Susan Yates

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