Education And Debate

Inquiry into homicides by psychiatric patients: systematic audit should replace mandatory inquiries

BMJ 1996; 313 doi: (Published 26 October 1996) Cite this as: BMJ 1996;313:1069
  1. Nigel Eastman, heada
  1. a Section of Forensic Psychiatry, St George's Hospital Medical School, London SW17 0RE
  • Accepted 21 June 1996

Inquiries into homicides committed by psychiatric patients are currently mandatory under Department of Health guidance. They are often broadly defined in their terms of reference and almost always address not only the cause of the incident but also professional skill, practice, and culpability. Concurrent pursuit of both purposes is unlikely to maximise “learning from experience.” Also, since inquiries can set their own thresholds for culpability, doctors can potentially be judged to a higher standard than would be required by the General Medical Council or negligence law. Lack of strict legal process increases the inherent potential unfairness to doctors. Investigation of cause and culpability should be separated and inquiries restricted to the former. There should also be a standing secretariat for inquiries to set terms of reference and to collate and distribute findings of inquiries. Widespread mandatory systematic audit of professional practice and service efficiency concerning risk assessment and management should largely replace costly ad hoc mandatory inquiries after homicides.

The Royal College of Psychiatrists' recent confidential inquiry into homicides and suicides by mentally disordered offenders identified 39 homicides committed over two periods totalling 26 months by patients who had had contact with psychiatric services in the preceding 12 months1; currently, there are in train in England and Wales 30 or so inquiries into homicides by mentally disordered people.2 What are the purposes of such inquiries? Are all the purposes best served by inquiries? Are inquiries fair to professionals?

An independent inquiry is currently mandatory3 (usually ordered and funded by the regional health authority, now the NHS Executive regional office) after any homicide by a mentally disordered person who has had recent psychiatric or social care. Unlike inquiries in the late 1960s into the mistreatment of (mainly) mentally handicapped or geriatric patients, but like inquiries in the …

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