Medicine And Books

Inquiries after Homicide

BMJ 1996; 312 doi: (Published 08 June 1996) Cite this as: BMJ 1996;312:1489
  1. A M P Kellam

    Ed Jill Peay Duckworth, £13.99, pp 182 ISBN 0 7156 2724 4

    Are psychiatrists paranoid when they feel that they are expected to accept responsibility for their patients' misdeeds while cynically being denied both the resources and the legal powers to control them? High on the list of factors inducing such feelings are the subjects of this book. Based on a seminar, Inquiries after Homicide explores in detail the many problems associated with such inquiries and suggests some possible solutions.

    The various types of inquiry are discussed by several eminent lawyers. They all seem to agree that there is a conflict between fact finding and the protection of witnesses who may well feel as if they are the accused. It is clear that, especially in non-statutory inquiries, which these are, witnesses “Enjoy no procedural rights beyond the general reach of natural justice”—itself apparently a variable concept.

    Contributors question why inquiries are mandated only after homicide by psychiatric patients and point out that suicides are dealt with more profitably and less publicly by the audit process. They also note that mental illness of itself produces a very modest increase in the risk of homicide, which is “only half that associated with alcohol and one third of the increase among those who abuse drugs.” At the start of his contribution Sir Louis Blom Cooper supplies the obvious answer: “The public inquiry has become a permanent feature of modern government as an instrument of dampening … public disquiet about a scandal or a disaster.” The value of these inquiries to the bereaved family, who may well be the only beneficiaries, is well discussed by Paul Rock who has researched this topic. The hard learned lessons from child abuse inquiries, which have a far longer history, are displayed in a chapter by Peter Reder and Sylvia Duncan.

    Further chapters consider how inquiries can fulfil their avowed primary functions of preventing, as far as possible, further homicides by influencing clinical practice and possibly also the allocation of resources on which this is often dependent. Nigel Eastman points out that emphasising a non-disciplinary approach and reducing the tendency to criticise individuals would reduce witnesses' defensiveness and the demoralisation of the existing services. He also argues for inquiries, if they cannot be avoided in most cases, to be centrally administered so that their findings can be centrally disseminated. David Carson adds that “it ought to be possible for an inquiry to report that ‘Nothing went wrong’” but suggests this is totally improbable and would disappoint the public.

    Possibly the Department of Health, which was represented at the seminar, will realise that holding 20 or more inquiries a year is self defeating. Few lessons can be learnt as no one will have time to read all the reports. The inquiries cost an estimated £250 000 each, a gross waste of resources. Above all Inquiries after Homicide underlines the need to disaggregate the disciplinary and fact finding functions and proceed with proper standards of fairness. Only then will a search for an explanation be likely to succeed and the learning of the appropriate lessons follow. One must bear in mind that para noia is by no means always delusional.—A M P KELLAM, consultant psychiatrist, Whitchurch Hospital, Cardiff

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