Mental Welfare Commission's role needs to be explained further

EDITOR—Alexander et al asked Scottish consultant psychiatrists about the helpfulness of various proceedings and events after the suicide of patients.1 The intervention of the Mental Welfare Commission was found to be unhelpful and is referred to, along with other enquiries, as contributing to a blame culture.

Although this undoubtedly accurately reports views expressed, it gives a misleading impression of the commission's role and practice. At one level, the statement is unexceptional; after all, the commission was not set up to be helpful to psychiatrists but to protect the welfare of patients. To associate the commission's involvement with the fostering of a blame culture, however, is a mistake.

The commission has a statutory duty to protect the welfare of those vulnerable through mental disorder, and to enquire into possible deficiency in care. In carrying out this duty it seeks reports on patients who commit suicide when in contact with mental health services or who have recently been in contact.

It receives about 100 reports each year, and these are considered at meetings of the commission. In a minority of cases, there may be follow up questions to obtain additional information. Relatives sometimes express concerns. In most cases the commission finds no concern about deficiency in care and carries out no enquiry. In a small number of cases, enquiry may be needed into deficiency in individual practice or service provision or both. Such infrequent enquiries are conducted in a spirit of finding solutions rather than culprits. The commission is as concerned as anyone else about the negative effects of a blame culture, which is often encouraged by the media. It does not wish to be tarred by the media's brush.

In Scotland, the Millan Committee is currently reviewing the Mental Health (Scotland) Act 1984, and, as part of that, the role of the Mental Welfare Commission. The Royal College of Psychiatrists in Scotland, in its response to the second consultation, has said that the Commission should undertake investigations into complaints about health care more frequently, and that it should have an independent power to publish its deficiency in care reports and more power to enforce its recommendations. Maybe it is human to support having a watchdog but to feel uncomfortable when it turns in your direction, especially in the aftermath of a distressing experience like suicide.