Unexpected deaths within psychiatric setting: A scoping review

Unexpected deaths have been associated with a variety of factors within the inpatient psychiatric setting.

This scoping review aims to evaluate the contributing/risk factors and preventive strategies of unexpected deaths.

This study is guided by the PRISMA extension for scoping review and the PRISMA 2020 statement. Six databases were searched from database inception to 18 December 2023, using the keywords: death* or mortality or autopsy AND (mental health) or psychiat* AND inpatient*. Studies published in English that explored the causes, contributing factors, risk factors, and preventive strategies of unexpected death within the inpatient psychiatric settings were included.

Twenty-seven articles were included. The articles explored contributing factors (100 %, n = 27), and strategies (59.3 %, n = 16) surrounding unexpected deaths within inpatient psychiatry setting. Studies attributed the causes to (1) medical conditions, (2) restraints, (3) asphyxia, and (4) catatonia or extreme agitation. Studies, mostly case reports, described deaths in those who utilised (5) antipsychotics but greater quality studies, such as case controls denied this association. Corresponding preventive strategies included, (1) medical assessment and treatment (especially cardiovascular disorders and their related risk factors), collaboration with medical physicians, staff training, staffing (increasing physician numbers), (2) usage of better alternatives like counselling, rapid tranquilisation, usage of restraints cautiously as a last resort with thorough observation, (3) risk assessment, training, (4) prompt treatment of catatonia and, (5) simplification of antipsychotic regimen.

More good quality studies are required to examine this controversial topic. An evidence-based understanding of this important topic can save lives in psychiatry.