Earlier this week I was interviewed by BBC radio about patient suicides in NHS psychiatric units. There were 4 suicides at one unit in Brighton, Mill View, in 2010 and the Hospital Trust responsible has just commissioned a very good independent report.
I have an interest in this area because I act for the families of a number of people who took their lives whilst they were supposed to have been in secure and caring environment. 4 occurred in other units run by Sussex Partnership NHS Trust, the same Trust that runs Mill View. All should have been avoided with proper care.
So what goes wrong? In my experience there are a number of common basic failures. First it is important properly to assess the risk of a patient harming themselves particularly when first admitted. It is not enough to take what ill patients say at face value.
Secondly, a patient at risk of self-harm needs to be observed frequently. Just how frequently is a matter of judgment. Observation can be intrusive but for a patient at risk of taking their own life safety must take precedence.
Some patients should be kept at ‘arms length’ or ‘eyesight’ observations. Others may be observed only every 15 minutes. But several of the cases I am dealing with involve patients who were able to take their own lives despite being under 15 minute observations. So deciding only to observe a patient every 15 minutes carries risks in some cases.
Thirdly, observations must be done. In one cases 2 nurses could not agree as to who should do the observations when and who should take their break. The patient was left for 45 minutes and found to have hung himself when they returned.
Fourthly, patients at risk should not be able to access plastic bags or items should as belts or shoe-laces. Suffocation and hanging are the 2 most common means of suicide in psychiatric units. Finally, units should not have ligature points strong enough to take someone’s weight.
Avoiding most of these factors is generally more a matter of common sense than complex medical judgment. Suicides in psychiatric units should always prompt proper investigation. The patients are highly vulnerable people who need care to ensure their safety. The sad truth is that many who succeed in taking their own lives do so because that care is not good enough.
Paul Sankey is a solicitor specialising in clinical negligence. If you or a member of your family have a clinical negligence enquiry please call our expert clinical negligence solicitors on 0800 916 9049, fill in our short online claim form and one of our specialist clinical negligence team will be in touch.