Safety is at the heart of good health care. In mental health services safety is particularly important but it is also an issue that raises sensitive questions. Where should the balance lie between patient protection and patient autonomy? How great is the risk to the public from mental illness? How many deaths could services prevent?
Avoidable Deaths, the latest report from the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, attempts to clarify these controversial areas. It provides definitive national figures for England and Wales on patient suicide and patient homicide. It describes the events that precede these incidents, the problems and warning signs on which future prevention must be based. The report covers five years of data collection, and the large number of cases allows a comprehensive examination of detail that is unique in this field of research. It also charts progress since complete national data collection began in 1997 – and there has been progress, particularly on the safety of in-patient wards.
In Avoidable Deaths, findings are also presented on sudden unexplained death on mental health wards, a new area of investigation for the Inquiry. Public and professional concerns have previously been expressed about the role of drug treatments and physical restraint in causing these deaths. Now, for the first time, we have information on the number of cases and the circumstances in which they occur.
The report highlights the areas of clinical practice that need to be strengthened if suicides, homicides and sudden deaths in mental health care are to be prevented, and it puts forward actions that services can take. Although it may be unrealistic to expect services to prevent all or even most of these deaths, the overall conclusion is both challenging and positive: many are avoidable.
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