29th July 2024
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Hospitals ordered to stop discharging people with severe mental illness
A review of safety has been ordered in response to a number of incidents where discharged patients with serious mental illness have killed others
“This is a welcome change of attitude. There’s been too many cases where families have been left counting the cost of action not being taken. Ultimately, we want to see a reduction in these deaths.” Julian Hendy, founder, Hundred Families
Hospitals have been ordered to carry out an urgent review of safety in NHS mental health services, following incidents where discharged patients have gone on to kill people, according to a report in the Times.
Since January 2020, there have been at least 233 killings committed by people with serious mental disorders, a Sunday Times investigation found.
NHS England has written to NHS trusts expressing concern that too many patients with severe conditions are struggling to access treatment.
In the letter, Claire Murdoch, NHS England’s mental health director in, told NHS psychiatric units to stop discharging mentally unwell patients simply because they do not turn up to appointments. She also said that psychiatric units should check for gaps in the care of people with severe mental illness, such as psychosis or paranoid schizophrenia.
The latest NHS guidance, which was issued alongside Murdoch’s letter, said there had been repeated “service failures”. These include patients not receiving consistent care, because of changes in staff, and NHS staff missing “red flags” such as criminal offending.
Warning from coroners about bed shortage
Families and carers have been ignored when they raised concerns, NHS England said.
Coroners have warned repeatedly about the shortage of mental health beds. The number of beds available each month has fallen by 5,600 since 2010.
Some killings have occurred after mental health patients had been discharged and left without medication or oversight. In her letter to hospitals, Murdoch said: “It is vital that DNAs [did not attends] are never used as a reason for discharge from care for this vulnerable patient group.”
She added: “Safety is a pivotal consideration.”
One example of NHS failings is that of Valdo Calocane who, in June last year, killed Grace O’Malley-Kumar, Barnaby Webber and Ian Coates in Nottingham city centre. Calocane had paranoid schizophrenia and had avoided psychiatric help for a year before the killings.
NHS England said: “While it is more likely that someone with severe mental illness will harm themselves rather than other people, serious untoward incidents such as the tragic events in Nottingham in 2023 serve to highlight the need for services to seek to engage and treat individuals that pose a risk of harm to others when unwell.”
It said that the health service had “a duty to provide care and treatment in a way that meets the needs of this group. Improving the care and treatment of individuals who require an intensive and assertive approach from health services is a priority for the NHS”.
Julian Hendy, founder of the Hundred Families charity, which supports those affected by mental health killings, welcomed the proposed reviews but told the Times: “The proof will be in the pudding because it’s all very well having policies in place but the crux will be, are they working and making a difference.”
He said he was pleased to see the NHS put an emphasis on people not being discharged without any follow-up and tougher outreach services for those who do not engage in treatment: “This is a welcome change of attitude. There’s been too many cases where families have been left counting the cost of action not being taken. Ultimately, we want to see a reduction in these deaths.”
Hendy said the results of the review should be published by the NHS.
FCC Insight
The NHS is right to call for a review of safety in mental health services. The high number of incidents in which people with serious mental illness have been discharged from care and then gone on to commit serious offences is a sign that processes for assessing risk and monitoring patients are not working as they should. This is likely to be a consequence of the strain NHS psychiatric services are under, and a lack of resourcing, as demonstrated by the drop in the number of available beds. Safety procedures need to be assessed as a matter of urgency, both to protect the public and to make sure that people with severe mental illness are receiving the care they need.
