Intended for healthcare professionals

Rapid response to:


Doctors are failing to identify patients most at risk of killing, report says

BMJ 2006; 333 doi: (Published 07 December 2006) Cite this as: BMJ 2006;333:1188

Rapid Response:

The mental health 'tsar's views on homicide by psychiatric patients

Cole reports, as has been reported in the media more widely, that the mental
health ’tsar’ believes that mental health services are not sensitised enough to
the risks of homicide by psychiatric patients.1,2 Staff are in fact
frightened they will be blamed in a homicide inquiry.3

mental health 'tsar' should support mental health services not attack them. I
wonder if there is a conflict of interest with his role as director of the
National Confidential Inquirythat produced the report Avoidable deaths.4
The report seems to take a more balanced view than some of the public comments
attributed to the ‘tsar’.

of the low incidence of homicide a high rate of false negatives does not necessarily
imply that risk assessment needs to be improved.5 Homicides by
psychiatric patients cannot be totally eliminated. Detecting high risk also
needs to be shown to make a difference to outcome. I am not encouraging a
culture of inevitability and want mental health services to be improved. This
requires creative support of their role in managing the risk of mental illness
on behalf of society.



  1. Cole A. Doctors are
    failing to identify patients most at risk of killing, report says. BMJ
    2006;333:1188 (9 December)
  2. Revill. J. One
    person a week killed by mentally ill
    , The Observer, December 3
  3. Double D. Challenge
    to mental health homicide rate. The Observer, 10 December 2006 [Full
  4. Avoidable
    Deaths—FiveYear Report of the National Confidential Inquiry
    into Suicideand Homicide by People With Mental Illness
  5. Crawford M.
    Homicide is impossible to predict.

Competing interests:
None declared

Competing interests: No competing interests

11 December 2006
D B Double
Consultant Psychiatrist
Norfolk & Waveney Mental Health Partnership NHS Trust