assessing risk of psychiatric patient violence to be scrutinised
by Angela Hussain
used by mental health professionals to assess the risk of patient
violence are to be scrutinised as part of a programme to reduce
the number of suicides and homicides by people with mental health
The Department of Health is to launch a “risk management programme”
in a bid to improve how psychiatrists, nurses and other professionals
assess the risk of patients becoming violent or suicidal.
The government says between 55 and 60 homicides are committed by
mental health patients per year, and around 1,000 people who have
used mental health services commit suicide per year.
government said last week it wants to develop a “national
evidence framework” for assessing and managing risk and to
develop guidance on information sharing between agencies about high-risk
In a related measure, the government is to review the care programme
approach (CPA) used by professionals to assess, plan, coordinate
and review care of patients.
This review will aim to look at ways to reform the “cumbersome”
and “bureaucratic” care planning process, and give patients
more control over their care and choice of treatment. Proposals
include strengthening the role of the care coordinator and improving
information sharing between health, social care and criminal justice
Mental Health Minister Rosie Winterton said: "We need to be
better at spotting the signs of danger, we need to improve the way
agencies work together and we need to provide care that will help
patients recover and regain their independence."
also emphasised that she plans to go ahead with supervised "community
treatment orders" (CTOs). Plans for CTOs are to be included
in a "streamlined" mental health bill. CTOs, already active
in Scotland, aim to ensure that patients discharged from compulsory
treatment in hospital continue to comply with treatment.
Sainsbury Centre for Mental Health has different homicide figures
to the government. It has previously stated that between 30 and
50 killings each year out of 800 are by people who are in contact
with mental health services. And critics are accusing the government
of failing to recognise that this "tiny" percentage of
all homicides committed by people with mental health problems has
not increased in the last 30 years.
argue that making sure patients receive care and treatment when
they request it will reduce violent or suicidal incidents more than
increasing compulsory treatment
health charity Mind’s chief executive, Paul Farmer, welcomed
the reform of the CPA. He said that " giving service users
choice over their own care is crucial to wellbeing and recovery.”
he added that the government should be focusing on giving people
"the right to help".
“It is too often the case with the rare homicides committed
by people with mental health problems that services have failed
to engage with people who are actually going and asking them for
help, let alone put together a care plan with them," he said.
"Mind urges the government to review its approach to amending
mental health legislation to ensure that the law empowers people
by giving them the right to help when they ask for it. This is the
best way to reduce the risk of tragic incidents occurring.
"Compulsory treatment cannot make any difference here, when
the problem is not that people are refusing treatment, but that
they are not being given treatment when they seek it."
Kathryn Hill, director of mental health programmes with the Mental
Health Foundation charity, said: "Despite what society is led
to believe people with mental health problems actually pose very
little danger to the public…Drugs and alcohol are a much bigger
factor in homicides than mental illness."
added that people with mental health problems are more often the
victims of violent crime and abuse both on the street and in inpatient
settings. A National Patient Safety Agency report, published in
July, revealed that from November 2003 to September 2005, there
were 44,000 reported harmful incidents inside mental health settings,
including 19 alleged rapes of patients. Most incidents were in inpatient
government’s measures are based on recommendations contained
in an independent review of homicides by people diagnosed with a severe
mental illness. It was carried out by Professor Tony Maden of Imperial
Professor Maden's report - Review of Homicides
by Patients with Severe Mental Illness (pdf)
21, 2006: Alleged rapes of NHS psychiatric patients “truly
shocking” - outrage as report claims 11 of 19 alleged
rapes were by staff.
23, 2006: Government drops key proposals of draft mental health
bill - new "streamlined” bill will be an amendment
to the present mental health act, says mental health minister Rosie
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