Psychiatric risk, safety cultures and homicide inquiries

Prosecuting psychiatric patients who assault staff: a New Zealand perspective

“…Although the investigation found no evidence that the assaults resulted from a failure to comply with local health and safety legislation, it did identify areas of improvement to minimize the risk of violent assault at the facility 17 . At an organizational level, various measures have been identified that play a crucial role in minimizing violence within the mental health system; these include managing staff’s lack of concern, poor morale, violation‐condoning norms, a ‘macho attitude’ and poorly expressed rules 19 …”

“…17 At an organizational level, various measures have been identified that play a crucial role in minimizing violence within the mental health system; these include managing staff's lack of concern, poor morale, violation-condoning norms, a 'macho attitude' and poorly expressed rules. 19 In New Zealand, there are no current national guidelines for prosecuting patients who assault within mental health services, even though this would be feasible, given the size of the country. Therefore, there is an onus to develop such a policy at the level of individual District Health Boards, who run and manage psychiatric units and hospitals in their region.…”

Application of Risk Assessment for Violence Methods to General Adult Psychiatry: A Selective Literature Review

“…Recognition of the safety culture of an organization is easier than defining it and unfortunately it is easier to understand when it is violated rather than adhered to. These factors, or their parallels, are commonly reported in homicide inquiries committed by people with mental illness [4,5], as are more general issue in relation to the structure of the mental health services as a whole, including resourcing, organization and appropriate legislation [17,18]. In other words, any disaster is seen as failure of safety culture [15].…”

“…There are similarities between the causation of accidents in general and homicides committed by mentally ill patients and one such similarity being the breakdown of safety culture of the organization where an accident or homicide takes place. A safety culture in mental health systems provides a matrix of infrastructure and expectation of performance of the systems and the individual practitioner [4]. Attributes commonly associated with violation of safety culture include lack of concern, poor morale, violation-condoning norms, a 'macho attitude' and poorly expressed rules [16].…”

From homicide inquiries to high secure hospital inquiries: a decade of social and political restrictive pressure on forensic psychiatry

“…This particular method of examining tragedies of this kind has been the subject of much intense criticism. Although some feel that the levels of homicide risk are high enough to warrant a concerted approach (Tidmarsh, 1997), others are of the view that the risk is insignificant compared to more common causes of death e.g. suicide, road traffic accidents (Szmukler, 2000), and Section 2 manslaughter may even be falling (Taylor & Gunn, 1999).…”