Independent inquiries into homicide

Since 1994 an independent inquiry has been required in all cases of homicide by discharged psychiatric patients in England and Wales.1 Psychiatrists have argued that these inquiries are inefficient, costly, misleading, and potentially unjust, yet their suggestions that they should cease, or be incorporated into other forms of audit,2 have not been adopted. Inquiries undoubtedly serve some important needs, but their failure to ask a consistent set of questions or develop a common methodology has limited their usefulness.3 In particular, many inquiries have not recognised the limitations inherent in the study of a single case.

Inquiries are important because they help relatives to find out what happened. Both relatives and the public want to know that everything that should have been done was done: they wish to see addressed the prima facie case that if someone is dead care must have been inadequate. Moroever, there is a widespread view, shared by some psychiatrists, that inquiries provide a way of assessing and improving services. But a lack of focus has limited the benefits.

The departments of health …