An independent review triggered by the death of six patients with mental health problems has expressed 'considerable concern' about the conduct of internal investigations at East Herts trust.

But the review, commissioned by East and North Hertfordshire health authority, says it would be 'difficult to conclude that the overall number of suicides. . . in the period under consideration can definitely be regarded as statistically 'abnormal''.

The review carried out by the Health Advisory Service follows a killing within the trust's drug and alcohol unit and five 'unexpected' deaths between January 1997 and March 1998.

HAS chief executive Professor Geoff Shepherd said it had concerns about the internal reporting and review process and identified 'the lack of indepth mental health experience' of the trust's internal review panel as a particular issue.

But he said standards of mental health services at the trust were 'average' and in some cases 'better than average'.

The HA said it would work with the trust, social services and voluntary groups to implement the review's proposals.

These include a review of acute ward resources, a check on the management of community mental health teams and further work on clinical risk assessment and management.