Campaigners have responded angrily to the proposals, which are due to be published in the next few weeks. The Department of Health has been anxious to reduce the number and cost of such inquiries and believes they undermine the morale of mental health staff.
The last Conservative government's disastrous "care in the community" policy led to the discharge from hospitals and care homes of many psychiatric patients, some of whom posed a serious threat to the public.After the random killing of Jonathan Zito by Christopher Clunis, who suffered from schizophrenia, at Finsbury Park tube station in London in 1992, fully independent inquiries have been held into all such deaths.
Since 1994, 65 inquiries have reported and another 25 are pending, at a cost of between pounds 70,000 and pounds 1m each. Under the new proposals these inquiries would become rare and undertaken only if "there is significant public interest and/or major national lessons to be learnt".
One campaigner asked: "How can you tell whether there are lessons to be learnt until you have had an inquiry? I believe there would be very few, if any, fully independent inquiries under these proposals."
Michael Howlett, of the Zito Trust, said his organisation had "severe reservations" about the proposals. "They require a local manager to look at a case and decide whether to refer it to a wider inquiry. Why would they? It is their job that is going to be accountable."
The proposals have been made by a special expert committee. The 11 members include the chief executive of the Mental Health Act Commission, William Bingley, and Professor Louis Appleby, a leading psychiatrist. It is not clear whether further consultation will take place.
According to Marjorie Wallace, chief executive of Sane, the mental health charity, the expert committee is known to be keen to end the "culture of blame" created by public inquiries, which adds to the stigmatisation of the mentally ill. However, she said that inquiries offered the only chance to spot patterns in the failure of the mental health services. A survey conducted by Sane of 33 inquiries in 1997 and 1998 found that 94 per cent had identified failures of communication and 73 per cent had found a failure to keep proper records. In more than half of the inquiries, the family or carers of the individual were not warned or consulted about the risks. More than one in four of the cases (27 per cent) were judged to be "predictable or preventable".
Ms Wallace said: "We don't want to add to the stigma but we believe you can't make progress if you do away with public inquiries. It is like throwing away the black box after a plane crash. Critics say `why frighten everybody when most people travel safely and only a few planes fall out of the sky?' We say there may be an underlying design fault and an inquiry is the only way of revealing everything that led up to a tragedy."
Mr Howlett said: "Unless there are independent inquiries it will become harder for families of the bereaved to find out exactly what went wrong."
The Government is proposing to replace public inquiries with two main levels of investigation. Lesser incidents, including serious assault and injuries to staff, service users or individuals, would be investigated by hospital managers.Most killings, as well as suicides and sudden deaths of patients, would be dealt with by new area committees made up of representatives from hospitals, social services and other agencies that provide health or social services.
In a recent article in the Journal of Mental Health Law, Anselm Eldergill, a Mental Health Act commissioner, predicted that the Department of Health would try to do away with fully independent inquiries. He drew attention to the parallel between mental health area committees andchild protection committees, which have recently come under criticism.
The Department of Health said yesterday that it did not wish to comment except to say: "We will look at the report with interest, when we receive it."Reuse content