Mental Health Inquiries in the Case of Homicide

Clinicians' experiences of inquiries following mental health related homicide: a qualitative study

OBJECTIVES

This aim of this qualitative study was to explore the experiences of clinicians involved with inquiries into the mental health care of patients who were perpetrators of homicide in New Zealand.

METHODS

Our purposive sample comprised ten clinicians working in New Zealand district health board mental health services. These clinicians were individually interviewed. Interviews were audio-recorded, transcribed and thematically analysed. The coding framework was checked and peer reviewed by an independent researcher.

RESULTS

Five themes were identified: the inquiry process; emotional burden; impact on team dynamics; changes to individual clinical practice; and perceptions of inquiries being influenced by organisational culture. Clinicians involved with inquiries reported significant anxiety and disrupted multidisciplinary team dynamics. Some participants found inquiries led to changes to their clinical practice and perceived that a punitive organisational culture limited learning.

CONCLUSIONS

Clinicians perceived inquiries as threatening, anxiety provoking and primarily concerned with protecting organisational interests. Communication of the inquiry process and ensuring inquiry findings are disseminated may enhance clinicians' experiences of inquiries and facilitate their participation and their reflection on changes to clinical practice that could contribute to improving services. Support for clinicians and multidisciplinary teams should be emphasised by the commissioning agency.

The conduct of inquiries: a qualitative study of the perspectives of panel members who investigate mental health related homicide

BACKGROUND

Inquiries into mental health related homicides may be held to identify failures in care and areas for improvement, accountability and to enhance public confidence. However, inquiries do not always achieve these aims.

AIM

The aim of this study was to explore the perspectives of members of inquiry panels who conduct inquiries into mental health related homicides in order to identify elements that would constitute a good inquiry.

METHODS

We selected a sample of inquiry panel members comprising 15 senior clinicians, legal experts and consumer advisors. Semi-structured interviews were audio-recorded, transcribed and analysed using thematic analysis.

RESULTS

Participants raised concerns related to: (1) orientation of the panel to the inquiry task; (2) clarity of the process; and (3) impact of the inquiry. Most participants recognised that inquiries require a focus on mental health systems and sensitivity to families and clinicians. They reported difficulties in clarifying purposes, attending to cultural aspects of the case, having a clear method tailored to the mental health context, formulating recommendations and disseminating findings.

CONCLUSIONS

Our participants perceived a number of weaknesses in the process by which inquiries into mental health related homicides had been conducted, and recommendations formulated and implemented. There is an opportunity to address these and thereby potentially improve the effectiveness and value of inquiries.

Contact with mental health services in the 12-month period before offending in a cohort of forensic order patients

There has been limited research examining the details of mental health service contact in the pre-offending period. A retrospective case-note study of the complete cohort of people found not criminally responsible or permanently unfit for trial in Queensland, Australia, was conducted. An electronic clinical database search for seven treatment event types in the 12-months pre-offence was conducted. Of the 123 eligible patients, half were recorded as having experienced at least one treatment event. There was a statistically significant increase in the number of patients experiencing a treatment-related event per month over this 12-month pre-offence period (increase of ∼1.4 patients per month, p < .001). The findings highlight the need for appropriate weight to be placed on both longitudinal and recent factors when undertaking routine clinical review or mental health assessment, or considering changes to a patient's diagnosis and treatment plan. Screening in custody and early intervention are also indicated to ensure appropriate treatment.