Editorial Comment: Take the pragmatic route

The tragic scale of murders by mental health patients was revealed last week by the National Confidential Inquiry. Researchers looking at homicides over a five-year period found that about 52 are committed each year in England and Wales, and suggest that failures in the system have contributed to some of these.

But, amid the ensuing media circus, some perspective was lost. It is important to note that the mental health system hasn’t  suddenly fallen apart – this homicide rate has been fairly static year-on-year. And, the report acknowledges that it would be unrealistic to expect services to be able to prevent all or even most of these deaths.

The report makes some key proposals to reduce homicide and suicide rates that should be acted on. About 1,300 patients kill  themselves each year, although this figure is gradually falling. A culture of acceptance surrounding these eventualities needs to be addressed, claims the report, with staff becoming too desensitised to the risks. A significant proportion of patients were  categorised as “low risk” before going on to either commit suicide or homicide.

There are also a range of proposals around in-patient management, including better observation and ward environment, and reducing the number of patients who abscond. But, possibly the biggest challenge is managing the transition of patients from the ward to the community, which is when most problems occur. Regular and intensive community support is needed during this period to keep patients on medication and well. The report also calls for services to look again at enhanced care under the Care Programme Approach and ensure that it is readily available, robust and monitored.

The government’s cause is well served by the sensationalist media coverage, and it has erroneously attempted to use the report findings as justification for its Mental Health Bill. Experts in the field have reacted angrily to the latest draft, and it faces a barrage of amendments as it passes through the House of Lords.

Balancing the rights of patients against public safety, and in turn patient protection against patient autonomy, is always difficult.

And while the report does say that compulsory community treatment might have a role in some cases preceded by non-compliance, it overwhelmingly supports pragmatic improvements to the current system. A hardened Mental Health Bill simply runs the risk of driving patients from services and damaging the civil liberties of people who have never committed an offence.

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