Written evidence submitted by HUNDEREDFAMILIES.ORG (MHB0013)
Thank you for the opportunity to respond to the Mental Health Act Draft Bill Call for Evidence. I am responding on behalf of the Hundredfamilies charity which supports families who have lost loved ones as a result of killings by people with serious mental illness.
We have documented nearly 2000 such homicides across the UK, assisted more than a hundred affected families, and consequently have a keen interest in the proposed changes to the Mental Health Act.
There are on average around 100 – 120 homicides by people with serious mental illness in the United Kingdom every year, a considerable proportion of the total number of recorded homicides. The vast majority (70-80%) occur within families and friends. (NCISH 2013)
We know from subsequent investigations that many of these cases result from seriously unwell people being unable, or unwilling, to access timely care and treatment before a tragedy occurs.
We have grave concerns the current proposals will make it much more difficult for people in crisis to access appropriate care and treatment in hospital, and that avoidable tragedies will result.
The Draft Bill proposes two new tests to fulfil the criteria for detention:
This would require clinicians not only to recognise the potential for ‘serious harm’ (which is undefined) but also to predict when it would occur. This is likely to be an impossible task.
We know from our work with hundreds of official NHS independent mental health homicide investigations that a failure to appreciate the real risks posed to others by a dangerous patient is a frequent and common feature of patient homicides. (Crichton 2011; Sussex 2016; Robinson et al 2018; HIW 2018; Niche 2022)
We know clinicians already struggle to recognise, assess, and manage seriously ill people who pose a risk to themselves or others. Many risk assessment tools currently in use are unable to predict accurately when violence by high-risk patients might occur. (Fazel 2012; NICE 2022)
Too often, assessments are made based on incomplete or inadequate evidence by clinicians who are not in possession of all the facts. (Lipsedge 1997; Niche 2015)
Too often, there is a failure to listen to the concerns of families and friends. (Sussex 2016)
We are concerned community mental health services are unable to adequately care for all those people in crisis who pose a risk to themselves or others, who consequently need urgent inpatient treatment. (BMA 2022)
We believe the proposals will not protect people who lack insight into their illness and who are at risk of causing serious harm to themselves, their families, or others.
We believe the proposal to raise the criteria for detention to those assessed as posing a threat of serious harm is highly flawed. It will lead to serious unintended consequences - more involvement by patients with criminal justice agencies, more serious incidents, and ultimately more avoidable deaths
In sum - raising the bar to secure admission to inpatient care will end in more tragedies.
We believe these proposals will not help patients and will not protect the public.
We would ask you to remove the threshold for ‘serious harm’ when considering detention from the current draft bill.
We hope these comments are clear, but please do not hesitate to contact us if you have any questions or need any further information.
Yours faithfully
Julian Hendy
Director
Hundredfamilies.org
Registered Charity: 1161287
12 September 2022
References
BMA - British Medical Association - (2022): Mental Health Pressures in England
Crichton John H.M (2011): A review of published independent inquiries in England into psychiatric patient homicide, 1995–2010, Journal of Forensic Psychiatry & Psychology, 2011, 1–29,
https://www.tandfonline.com/doi/abs/10.1080/14789949.2011.617832
https://www.bmj.com/content/345/bmj.e4692
HIW (2018): Health Inspectorate Wales, Independent External Review of Homicides. An evaluation of reviews undertaken by Healthcare Inspectorate Wales since 2007
Jackson H, Wray J, Gardiner E, Flanagan T. (2019): Involving carers in risk assessment: a study of a structured dialogue between mental health nurses and carers. Journal of Research in Nursing. 2019;24(5):330-341.
https://journals.sagepub.com/doi/abs/10.1177/1744987119851533
Lipsedge M & Ruddenham Bland S, (1997): Review of 11 independent inquiries into homicide by psychiatric patients, Clinical Risk (1997) 3. 171-177
https://journals.sagepub.com/doi/abs/10.1177/135626229700300601?journalCode=crib
NCISH (2013): National Confidential Inquiry into Suicide and Homicide by people with mental illness, Annual Report, 2013
https://www.hundredfamilies.org/wp/wp-content/uploads/2014/11/Screen-Shot-2014-09-03-at-12.42.09.png
NICE (2022): National Institute for Health and Care Excellence, Guideline. Self-harm: assessment, management and preventing recurrence. January 2022
https://www.nice.org.uk/guidance/ng225/documents/draft-guideline
Niche Patient Safety (2015): What safety lessons can we learn? – Thematic Review of Independent Investigations. Manchester
Niche (2022): Learning Compendium - A thematic review of mental health homicide investigations April 2022.
https://www.nicheconsult.co.uk/wp-content/uploads/2022/07/Niche-Learning-Compendium-2022.pdf
Robinson AL, Ress A & Dehaghani R (2018): Findings from a thematic analysis of reviews into adult deaths in Wales: Domestic Homicide Reviews, Adult Practice Reviews and Mental Health Homicide Reviews, Cardiff University.
https://orca.cardiff.ac.uk/id/eprint/111010/
Sussex Partnership NHS Foundation Trust, Caring Solutions. (2016): An independent thematic review of investigations into the care and treatment provided to services users who have committed a homicide and to a victim of homicide by Sussex Partnership Trust.
https://www.england.nhs.uk/south/wp-content/uploads/sites/6/2016/10/thematic-review-vol1.pdf