Suicide and homicide more likely for mental health patients due to ‘tick-box’ risk approach, says Manchester study

By Colin Rhodes

Patients suffering from mental illness are at a greater risk of dying by suicide or committing homicide due to the ‘tick-box’ approach to risk assessment, Manchester researchers claim.

Concerns about the way in which risk is assessed for vulnerable and mentally ill patients is raised by a study conducted by the University of Manchester’s National Confidential Inquiry (NCI).

In more than 80 sample cases where risk had been assessed as low the patient died by suicide or committed homicide within seven days.

In a third of these the overall risk assessment was deemed unsatisfactory by the researchers.

Professor Louis Appleby, from the University’s Centre for Behaviour and Mental Health, said: “The results suggest that there is a need for greater risk management to be individually tailored, or personalised, to each patient rather than following a ‘tick-box’ approach.

 “In a small but significant number of cases, even when risk was recognised, appropriate management did not follow, for example patients were granted unescorted leave within a few hours of detention for acute psychosis.

“This could be the consequence of a ‘tick-box’ approach to risk assessment, something that has been widely criticised by clinicians.” 

The researchers developed a framework for evaluating the quality of risk assessment and management in mental health patients based on existing best practice guidelines.

These included taking into account the patient’s history, mental state and current circumstances.

It also entailed an overall judgment of the risk factors, a management plan, communication of the management plan and overall quality of assessment.

The Suicide and Homicide by People with Mental Illness report, commissioned by the Healthcare Quality Improvement Partnership, found that unsatisfactory assessments before a homicide were often associated with a diagnosis of personality disorder or alcohol misuse.

Picture courtesy of Jugbo, with thanks.

For more on this story and many others, follow Mancunian Matters on Twitter and Facebook.

Related Articles