Sectioned patients' deaths 'hide failures'


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The Independent Online

Five mentally ill people are dying in hospital every week on average amid claims that failures are being covered-up and lessons not being learnt.

At least 261 sectioned hospital patients in England are known to have died in 2011, compared to 189 deaths in prison and 31 in police custody in England and Wales, The Independent can reveal.

The deaths involve vulnerable people deprived of their liberty under the Mental Health Act by the state. Yet families rely heavily upon investigations carried out by the same hospital trust responsible for their loved ones care.

In stark contrast, all deaths which occur in police, prison or immigration custody are immediately subject to independent investigation by either the Independent Police Complaints Commission or Prison and Probation Ombudsman. This independent body coupled with a later inquest means that these custodial deaths are investigated in compliance with Article 2, the right to life, of the European Convention of Human Rights.

An article 2 compliant investigation must be initiated by the state, independent, effective, open to public scrutiny, reasonably prompt and involve the family. The goal is to learn lessons to prevent future deaths.

Historically mental health deaths were excluded from this level of scrutiny. But a landmark ruling in 2008 from the House of Lords declared hospitals have a duty to reasonably protect detained psychiatric patients from taking their own lives. The case involved the death of sectioned patient Carole Savage, aged 49, in July 2004, who committed suicide by jumping in front of a train after leaving hospital unnoticed.

The ruling meant that investigations into unexpected deaths or when failures of care were suspected should comply with Article 2. The Government has since insisted that inquests can expand to fulfil this function, if the coroner deems it necessary.

Four years later there is growing unease about the reality on the ground. Many families still face huge obstacles trying to find out the truth from internal investigations, according to The Independent Advisory Panel on Deaths in Custody (IAPDC).

Lawyers argue that coroners vary substantially in the way they conduct such inquests. For example, deaths in prison and police custody automatically trigger a jury inquest, whereas the coroner decides whether one is needed in mental health deaths.

Legal representation is rare, especially in deaths categorised as ‘natural causes’, as legal aid is only granted in “exceptional” circumstances. This makes it much harder for families to challenge the independence of expert evidence, witnesses and scope of the inquiry.

Philip Leach, professor of human rights at London Metropolitan University and member of IAPDC, said there was a “lack of understanding and complacency” among health officials regarding their far reaching duty to investigate deaths and learn lessons.

“There is no doubt that a national, independent body would be the best way to ensure any death in the mental health sector where there is a possibility of hospital failures is properly investigated.”

A total of 3,628 detained mental health patients died between 2000 and 2010 – 60 per cent of all custodial deaths. Around three quarters are classified as ‘natural causes’.

The IAPDC, which advises ministers, say information about internal mental health investigations is scant and inconsistent.

Lord Toby Harris, chair of the Panel said: “It is striking that in mental health, institutions investigate themselves. This makes concerns about cover-ups very difficult to disprove.”

He added: “There are too many instances of people dying prematurely of ‘natural causes’ in mental health sector, which are not properly being analysed.”

Jane Antoniou, 53, apparently took her own life while detained under the Mental Health Act at Northwick Park Hospital in October 2010. A respected campaigner with a long history of serious mental illness, she was admitted to hospital following a suicide attempt and died nine days later in hospital.

Her husband, Dr Michael Antoniou, has started legal proceedings against the NHS trust and department of health for failing to carry out an independent investigation. The judicial review has been stayed until the inquest in April.

Deborah Coles Co-Director of campaign group Inquest said: “The defensive and closed nature of the investigation process has resulted in a culture of secrecy and complacency over the shocking number of psychiatric deaths. They are not subject to robust public scrutiny and proper systems of accountability which could identify systemic failings that safeguard lives in the future.”

A Department of Health spokesman said: “It is vital that the NHS learns from each suicide and strives to ensure it doesn't happen again. This is why all suicides in hospital will be investigated by the coroner at a public, independent inquest. This complies with Article 2 (right to life) of the European Convention on Human Rights”  

Case Study: 'Things will now be better for others'

A landmark Supreme Court ruling on Wednesday means there is now the same duty to protect vulnerable "voluntary" mental health patients.

The case was brought by Gillian and Richard Rabone, whose depressed daughter Melanie hanged herself in 2005 aged 24 after being given home leave against their wishes. A note in her file said she should be assessed for compulsory detention if she tried to leave psychiatric care.

Pennine Care NHS Trust's internal investigation took two years; the report was "watered down" several times and key witness statements omitted. The inquest lasted only half a day; the only expert witness was the doctor who had let her go.

"We heard nothing from the trust until we complained four months after Melanie died. We know now things had gone blatantly wrong, but no one told us anything, they were always trying to cover their backs. Knowing what we now know, we really regret not having a lawyer at the inquest. But all this made us even more determined. We'll never get Melanie back but at least now things will be better for people coming along behind."