Healthcare Inspectorate Wales publishes reports on homicides

The Healthcare Inspectorate Wales (HIW) has this week published its reports following reviews of two homicides carried out by mental health service users in Cardiff and Gwent.

The reviews have highlighted concerns in relation to the adequacy of care and treatment provided to Deborah Hancock and Wayne Royston.

A spokesman for HIW said that while the circumstances and details of both cases were very different, there are common findings. These are:

• A lack of integrated and co-ordinated services in each case.
• Inadequacies in the provision of services for those individuals with a personality disorder and criteria set for access to mental health services that exclude such individuals from receiving appropriate support and treatment.
• The lack of a proactive approach to the provision of care, treatment and support where individuals are difficult to engage with.
• An immaturity in the application of the Care Programme Approach and Unified Assessment Process, including inadequate attention to the assessment, identification and management of risk.
• Poor communication and systems for information sharing across agencies and between organisations.

Chief Executive of HIW, Dr Peter Higson, said: “There are important lessons to be learned from both of these tragic cases to ensure that mental health services are better able to minimise the risk of similar incidents in the future.”

Responding to the reports, Ann Lloyd, Chief Exectuive of NHS Wales and head of the Assembly Government’s Health and Social Services department said: “The reports show that neither of the incidents was predictable, but there were shortcomings in the care of the two individuals.

“While people will be naturally concerned at the publication of these reports, I would like to emphasise that people living with a mental health condition are more likely to be the victims of harm rather than the perpetrators of harm. I would stress that events such as these are terribly distressing but very rare.

“The Mental Health Act 2007, most of whose provisions come into force in October this year, will reduce the risk of people being excluded because they don’t fit into certain medical categories, for example personality disorders.

“Indeed, this will be further strengthened with the new powers the Assembly is seeking on mental health services, which will allow the Assembly to bring forward Measures giving rights to early assessment and treatment. This will help diminish risk even further.”

Bill Walden-Jones, Chief Executive of Hafal, the principal Welsh charity for people with serious mental illness, said: “A range of issues has been raised by both reports, including problems with communication and which agency takes responsibility for the patient.

“But at the root of all these problems is a fundamental weakness in care planning. In both these cases, the lack of a methodical care plan is evident.

“The Care Plan Approach (CPA), which aims to address this issue, is patchy in its implementation across Wales. CPA provides a tool for care planning that sets out who is responsible for what and enable different agencies to work effectively together, and Hafal has campaigned for CPA to be fully rolled-out across Wales.

“Hafal has also been closely involved in the development of proposed new mental health legislation for Wales, which would include a right to early treatment and effective care planning.

“This will not only improve the care received by people with a serious mental illness but will also enhance the safety of all concerned.”