Concerns over deaths of psychiatric clients

New research from the Mental Health Act Commission has
highlighted the number of deaths of psychiatric patients during and
after detention under mental health legislation.

The study, which closely follows the publication of a report by
the National Confidential Inquiry into Suicide and Homicide by
People with Mental Illness, looked at the cases of 1,471 people who
died between 1997 and 2000.

More than 1,200 deaths were from natural causes – three-quarters
of which were of people over 65. Commission chairperson Margaret
Clayton said it was worrying that a large proportion of deaths from
natural causes occurred within four weeks of admission to hospital,
although some deaths were to be expected. She suggested that
physical ill-health among older people in detention was not being
picked up or dealt with quickly enough.

The commission also investigated 253 “unnatural deaths”
resulting in inquests. Hanging, including strangulation, was the
most common way for patients to commit suicide.

Many suicides also occurred away from hospital premises. Nearly
20 per cent of those who committed suicide were on agreed leave,
suggesting that the suicide risk was not anticipated. A third were
absent from hospital without leave which, says the commission,
implies that staff were “caught unawares”.

Clayton said that many people admitted to hospital were already
considered a risk to themselves, and that the efforts of staff
saved countless lives. But she said the commission wanted to see
improved risk assessment procedures for patients before leave was
agreed, and better security to prevent patients leaving hospital
grounds without permission.

The research also looked at the use of restraint for psychiatric
patients. In 22 instances records showed that restraint had been
used in the week before someone died. Two people died while they
were being restrained, and another four died less than four hours
after being restrained. The commission has recommended that use of
restraint should be looked at in the event of a death, and has
called for a detailed post-death audit to take place after
“unexplained or unnatural deaths”.

Cliff Prior, chief executive of the National Schizophrenia
Fellowship, backed the commission’s call for research into the use
of restraint. “It is unacceptable that people detained under the
Mental Health Act 1983 should die in this way,” he said. “The act
can be a lifesaver, but it is a powerful instrument and must be
used correctly.”

The NSF joined other mental health organisations this week to
take part in the Mental Health Alliance “week of action” to remind
the government of their commitment in the mental health white paper
published in December to reduce the use of compulsory powers.