Improving patient care

Improving patient care

Patient safety or patient risk?

The case of people who are mentally ill

Penny RhodesBradford Institute for Health Research

Freed mentally ill prisoners could 'bump someone off' - but they should NOT be in prison, claims Ken Clarke

Daily Mail 13 December 2010

Increasing the risks to the most vulnerable elements of society, such as children, by releasing offenders with mental disorders could be argued as challenging common sense?

Daily Mail 13 December 2010

Every year, 100 people are killed by someone who has mental health problems.

Daily Mail 13 December 2010

People with severe mental illness are responsible for one in 20 violent crimes, researchers say.

 http://www.suite101 Friday, 28 July 2006

Every year, 100 people are killed by someone who has mental health problems.

Daily Mail 13 December 2010

People with severe mental illness are responsible for one in 20 violent crimes, researchers say.

 http://www.suite101 Friday, 28 July 2006

Crisis Resolution and Home Treatment teams

•  offer an alternative to hospital care

• provide intensive, time-limited, home-based treatment

• act as a “gatekeeper” to mental health services whereby individuals are referred to the most appropriate service

• provide a 24 hours a day, 7 days a week multi-disciplinary, community-based treatment service

• be actively involved in discharge planning

• provide intensive care at home to enable early discharge

• ensure that individuals are treated in the least restrictive environment and as close to home as possible

Department of Health 2001

We found: •When asked about safety, workers spoke about staff safety. •Workers seemed not to understand what we meant by ‘patient safety’.  •Instead, they talked about ‘risk’

The discourse of safety related almost entirely to staff safety. 

 The discourse of patient risk superseded that of patient safety.

Patients at risk

•they may be disoriented or confused as a consequence of their illness and/or medication •their views may be discounted on grounds of mental incapacity •physical symptoms may be missed or wrongly attributed to mental illness   

• increasing administration of medication in community, as opposed to more controlled environment of hospital

 • increasing treatment against patients’

wishes (compulsory treatment orders) • antipsychotic drugs among those most

frequently associated with severe harm 

Patients at risk

 •Majority of incidents from inpatient services •Most incidents concerned: patient accidents; disruptive / aggressive behaviour; self-harming behaviour; absconding or missing patients.  •MH trusts report lowest average number of medication incidents, except for ambulance trusts and PCTs.  

National Patient Safety Agency (2006) report on incidents in mental health services

National Patient Safety Agency (2006) report on incidents in mental health services

• Antipsychotics among the medicines most frequently associated with severe harm.

• Likely to be significant under-reporting. • Reports about medication, clinical assessment

and treatment may be particularly under-reported.

 • Bias towards reporting more serious incidents

MIND (2008) submission to the House of Commons Health Select Committee on Patient Safety

•general safety: assault, threats and feeling unsafe on mental health wards •sexual safety on mental health wards

•reporting crimes (in hospitals)  

• protection from abuse (from staff)

• complaints poorly handled

• need for third-party reporting schemes

• need for training for staff

• prescribing practices - serious adverse effects

MIND (2008) submission to the House of Commons Health Select Committee on Patient Safety

" excessive anxiety around the risks posed by people experiencing mental distress, and insufficient concern as to the risks posed to them by poor services".

Safety from staff

Safety from the general public

Safety from poor services 

Risk management for whom? •to protect patients from harming others or themselves

•to protect the service’s back e.g. from liability claims

•to protect the service from adverse publicity

•to satisfy politicians responding to media and public pressure

•national policy drivers e.g. suicide reduction

What are the ways forward?

Ways forward? 1.See safety as a wider issue

2.More research about how MH practitioners practice safe care

3.Better reporting of safety incidents and better feedback and learning   

Ways forward?  4.Less punitive approach to error

5.Refocus debate onto independent living and support in the community

6.Litigation a double-edged sword?

7.Public protection should not over-shadow patient safety

Fury at escape of killer schizo The 25st killer gave guards the slip when allowed out of a secure mental hospital WITHOUT handcuffs. Sun 17 Nov 2009

Why was he on the

streets? The ‘prophet of

God’ who decapitated

British woman in Tenerife

Mail Online 14 may 2011 ‘Schizophrenic kills brother, 9, with a kitchen knife’ Sun 20 Feb 2010

Public Health Perspective  

Data from a representative sample of 1,151 remanded

offenders who underwent a full structured diagnostic interview

 

RESULTS

About 3% of violent offenses could be attributed to individuals

with a principal diagnosis not related to substance use.

An additional 7% of violent offenses could be attributed to

individuals with a primary diagnosis of a substance use disorder.

 

CONCLUSION

‘Public perceptions of mentally ill persons as criminally

dangerous appear to be greatly exaggerated.’Stuart & Arboleda-Flórez, 2001

Murder risk 'higher for mentally ill'

 The mentally ill are:

 • frequently victims of violent crime

 • six times more likely to be murdered than the

general population

 • have higher death rates from suicide and

accidental causes.  

http://www.suite101.com Friday, 21 December, 2001