Consequences for Clinicians and Mental Health Services of a Homicide by a Current or Recent Patient: A European Union (EU) Wide Survey

Abstract

Contributors

Hans Schanda (Austria), Kris Goethals (Belgium), Peter Marinov (Bulgaria), Neophytos Papaneophytou (Cyprus), Jan Vevera (Czech Republic), Tina Gram Larsen (Denmark), Andres Lehtmets (Estonia), Hanna Putkonen (Finland), Florence Thibaut (France), Norbert Nedopil (Germany), Giogos Alevizopoulos (Greece), Peter Silfin (Hungary), Enda Dooley (Ireland), Francesca Villanti (Italy), Ingrida Cera (Latvia), Hans-Gerd Gumprecht (Luxembourg), Anton Grech (Malta), Ellen van Lier (Netherlands), Knut Rypdal (Norway), Małgorzata Opio (Poland), Máximo Fernández Colón (Portugal), Nicoleta Tataru (Romania), Lubomira Izakova (Slovakia), Peter Pregelj (Slovenia), Esperanza Gomez (Spain), Per Lindqvist (Sweden), Marc Graf (Switzerland), Jenny Shaw, Christine Kennedy, John Crighton (England & Wales, Northern Ireland and Scotland respectively, United Kingdom [UK]).

When a mental health service user kills, concerns arise about that service. Our aim was to examine consequent reviews of services across the European Union (EU), Norway, and Switzerland. A systematic review of published literature and a questionnaire survey with a psychiatrist with forensic expertise from each EU country, Switzerland, and Norway were completed. Collated findings were circulated to respondents for correction and/or further observations. There were no relevant journal publications from the EU outside the UK. Survey responses came from 28 of 30 countries surveyed. An inquiry almost always occurred in four countries and at least sometimes in all but five others. Where an inquiry occurred, it was generally internal rather than by an independent body. The UK has a national inquiry database; Norway, the Netherlands, and Finland collect similar data nationally, but most EU countries do not. Legal (civil or criminal) or disciplinary proceedings were uncommon anywhere, but in France and in Italy a treating psychiatrist has been convicted of manslaughter; service authorities appear more-or-less immune everywhere. Except where inquiry is invariable, victims' relatives generally drive actions. The concept of individual inquiry after homicide is widely recognised and often occurs, but practice varies. The impact of such process still requires evaluation.

Keywords:

• homicide, homicide inquiries, mental health services, European Union

APPENDIX

A Cardiff-based medical student, Lizzie Holliday, and I are trying to find out whether there are any systems responses to services after a person who has been in contact with mental health services commits a homicide. (We are not here interested in criminal proceedings against the perpetrator.) In England and Wales, for example, there might be an internal service inquiry, which I would say is almost inevitable, probably an external, independent inquiry and we have a national database in the National Confidential Inquiry into Suicide and Homicide. There is also a theoretical possibility of civil or disciplinary proceedings or even criminal charges against the clinician who was in charge of the perpetrator's case.

We would be grateful if you could tell us what proceedings may follow in [your country].

Please highlight or tick the correct responses for [your country] to the items below, then indicate whether there is a key publication or website which we should look at.

After a homicide by a person who has been in contact with psychiatric services:

1. An internal inquiry would be: invariable; usual; unusual; never happens

2. An independent inquiry would be: invariable; usual; unusual; never happens

3. We have a national database specifically for such incidents: yes/no

4. Civil action against the clinician responsible for the case is: invariable; usual; unusual; never happens

5. Disciplinary action against the clinician responsible for the case is: invariable; usual; unusual; never happens

6. Criminal action against the clinician responsible for the case is: invariable; usual; unusual; never happens

7. We have other approaches (if so, please describe):

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8. A key publication is (please mark none if there isn't one):

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9. A good website which will explain more is (please mark none if there isn't one):

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With many thanks, in anticipation, for your help. We will provide you with feedback as we accumulate replies from other countries too. Would you like to be included in any publication?