Fears over listing of mentally ill at risk

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PSYCHIATRISTS fear that new requirements to keep supervision registers identifying mental patients at risk of harming themselves or others will expose them to claims of negligence if they fail to include a patient who later commits suicide or murder.

The Royal College of Psychiatrists is in discussion with officials from the Department of Health to try to clarify guidelines for keeping the registers, which come into effect next month.

The new regulations requiring psychiatric units to keep supervision registers were announced last December by Virginia Bottomley, Secretary of State for Health, after a series of incidents involving schizophrenics, supposedly receiving psychiatric care, who had harmed themselves or others.

These included the case of Ben Silcock, who climbed into the lion's den at London Zoo, and Christopher Clunis, who killed a stranger, Jonathan Zito, on a London Underground station.

Last month the Royal College of Psychiatrists published a report revealing there had been 34 killings by severely mentally ill people who had been in contact with psychiatric services in the previous 12 months.

Psychiatrists are worried that they will be made the 'fall guys' and scapegoats if future tragedies occur because supervision registers will place much of the burden of responsibility and accountability on their shoulders.

In a letter to Mrs Bottomley, Dr Fiona Caldicott, president of the Royal College of Psychiatrists, expressed consultants' 'strong concerns' about the guidelines: 'While we support the introduction of a mechanism to document a smaller group of patients who require close supervision and care, there is a very strong view that the current proposals are unlikely to succeed . . .'

She said the criteria for inclusion on the register were too broad and the numbers of patients inolved were likely to be considerably higher than intended. The guidance document implied that anybody with a severe mental illness, as well as severe personality disorder and psychopathic disorder, who has either aggressive tendencies or a risk of suicide or self-neglect, should be included. This would involve a 'considerable proportion' of all patients in psychiatric care.

Dr Caldicott continued: 'The measurement of risk of suicide or self- harm cannot always be precise. While the minimisation of risk has always been a guiding principle of clinical practice, risk cannot be elimated.'

Initially, Mrs Bottomley rejected most of Dr Caldicott's criticisms.

But Dr Caldicott is hopeful that the department will issue new guidelines making it clear that the number of people registered should be kept to a minimum, and if this happened the costs of administering them would be less than the original pounds 77m estimate.