Every person with schizophrenia should be subject to an enhanced
multidisciplinary care programme designed to prevent suicide and
homicide, an influential inquiry has recommended.
The National Confidential Inquiry into suicide and homicide by
people with mental illness, chaired by mental health tsar Louis
Appleby, has made the suggestion as part of its final report.
It reveals wide variations in the use of the enhanced care
programme approach, introduced in the early 1990s to ensure that
people with severe mental health problems received ongoing care
from all agencies.
The research looked at those in contact with services within the
previous year, and found that half of suicides and a third of
homicides were committed by people who were already subject to
enhanced CPA. But a significant proportion of those who committed
suicide were not complying with treatment or had missed their last
The research also found that a quarter of schizophrenics who
committed suicide after having been in contact with mental health
services, and nearly half of those who killed someone else, had not
been placed on enhanced CPA.
The inquiry recommends a “major overhaul” of the enhanced care
programme approach, with the development of national criteria for
its use. It calls for all those with a diagnosis of schizophrenia.
People with severe mental illness and a history of self-harm or
violence, or who are homeless or are lone parents, should also be
subject to enhanced CPA.
Janet Sherrat, clinical research fellow to the National
Confidential Inquiry, said the findings demonstrated that the use
of the enhanced CPA was not rigorous enough. She said that in some
cases risks had not been recognised, while in others, although the
person had been recognised as at risk, they had been allowed to
lose contact with services. The recommendations were intended to
make use of enhanced CPA more consistent across England and