'Media coverage of mental health killings obliterates shades of grey'

Our investigation into the aftermath of killings by mental health patients, published last week on hsj.co.uk, reveals failings in their care are regularly taking up to five years to put right.

Patients and the public are being needlessly put at risk by the unacceptable time it takes to make improvements.

While the public's interest in killings by mental health patients is almost always focused on protecting 'us' from 'them', those who have committed the crimes are also victims. Such extreme violence is the denouement of years, often decades, of a deeply troubled life.

Strategic health authorities are obliged to order an inquiry. Too often these are delayed so long they become irrelevant, and findings can take years to implement.

The Department of Health's 2005 guidance to SHAs says simply that the SHA should establish an independent investigation 'as soon as possible'. This imprecise wording has been subject to widely differing interpretations, with some SHAs stalling on action until the last dot and comma of criminal proceedings is completed.

Sometimes this is caused by legitimate concerns about prejudicing a court case, but in others there is the whiff of kicking a public relations problem into the long grass, not to emerge until staff have moved on and the media has lost interest.

The latter course is understandable. Coverage of mental health killings obliterates shades of grey. Mental health professionals are pilloried in vituperative language. The 'facts' are laid out in a few neat column inches, allowing instant experts propping up the nation's bars to lament the stupidity and incompetence that allowed such obvious warning signs to be missed.

An understanding of risk, or the moral and practical limitations on locking up everyone who may pose a threat, or the sheer workload mental health services have to cope with, are all but absent.

But delays in holding inquiries only magnify the risks inherent in the mental health system. The lessons to be learned from these cases do, sadly, run along well-worn paths - communication failures, poor record-keeping, weaknesses in risk assessment and training.

Timely, effective action is essential to reduce the loss of around 50 lives a year, as well as meet the care needs of patients and restore public confidence.