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

Area of Science:

• Forensic Psychiatry
• Healthcare Policy
• Medical Law

Background:

• Mandatory inquiries into homicides by psychiatric patients are common under Department of Health guidance.
• These inquiries often assess incident causes, professional practice, and culpability concurrently.
• Current practices may not optimize learning and can unfairly judge doctors.

Purpose of the Study:

• To evaluate the effectiveness of current inquiry structures for homicides by psychiatric patients.
• To propose improvements for the investigation process, focusing on learning and fairness.
• To advocate for a shift towards systematic audits over ad hoc inquiries.

Main Methods:

• Analysis of current Department of Health guidance on mandatory inquiries.
• Review of the scope and impact of existing inquiry processes.
• Comparative assessment of inquiry findings versus professional standards (General Medical Council, negligence law).

Main Results:

• Concurrent investigation of cause and culpability hinders "learning from experience."
• Doctors may face higher culpability standards than legal or professional benchmarks.
• Lack of strict legal process in inquiries increases potential unfairness to medical professionals.

Conclusions:

• Separate investigation of cause and culpability is recommended, with inquiries focusing solely on the cause.
• A standing secretariat for inquiries is proposed to standardize terms of reference and disseminate findings.
• Widespread mandatory systematic audits of risk assessment and management should replace costly, ad hoc mandatory inquiries.