New report highlights deaths of psychiatric patients in detention

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

The study looked at the cases of 1471 people who died between
1997 and 2000. It closely follows the publication of a report by
the National Confidential Inquiry into Suicide and Homicide by
People with Mental Illness.

More than 1200 deaths were from natural causes – three quarters
of whom were over 65. Commission chairperson Margaret Clayton said
that although a proportion of deaths were to be expected, it was
worrying that a large proportion of deaths from natural causes
occurred within four weeks of admission to hospital. She suggested
that physical ill-health among elderly 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 found
to be the most common way for patients to commit suicide.

A large number of suicides also occurred away from hospital
premises. Nearly twenty per cent of those who committed suicide
were on agreed leave, suggesting that the suicide risk was not
anticipated by care staff. A third were absent from hospital
without leave, which the MHAC argues implies that staff were
“caught unawares”.

Clayton stressed that many people admitted to hospital were
already considered a risk to themselves, and said 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 every
“unexplained or unnatural death”.

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 should die in this way,” he said. “The act can be
a lifesaver, but it is a powerful instrument and must be used
correctly.”