Deaths in mental health facilities arising from mismanagement
13 May 2015
When a person is admitted to a psychiatric hospital, especially where the individual is given ‘involuntary patient’ status, the hospital has a responsibility to ensure that the person suffers no harm. It is not uncommon in our practice to receive enquiries from the families of patients who have died or suffered serious injury following mismanagement in a psychiatric facility.
Given that suicide and suicidal ideation is associated with a number of mental illnesses, it is important that psychiatric facilities take care to ensure that patients are managed appropriately to minimise the risk of suicide occurring in the hospital setting.
Hospital staff should ensure that an adequate risk assessment is performed as early as possible on admission of the patient. If there is a delay in having the formal psychiatric assessment, nursing or other staff should ensure that there is engagement with the patient and preliminary risk assessment performed, including examining the patient’s belongings and removing any potentially harmful objects.
Should these processes not be followed, tragedy and fatalities can occur and one of the most contentious legal issues becomes whether or not the outcome was avoidable with the use of reasonable care and skill. A recent case Maurice Blackburn was involved in concerned a man admitted to a psychiatric facility from another hospital following two suicide attempts at that hospital. At the time of transferring him he was being nursed on a 1:1 basis with constant observation to prevent harm and the risk of a further suicide attempt. At the second psychiatric hospital, the man was placed in a room out of sight of the nurses’ station and he was placed on 15-minutely observations. There was a delay in performing the formal psychiatric evaluation and during that time in between observations, he committed suicide by hanging. The case is currently in litigation.
A standard defence to a claim such as this is that the plaintiff cannot prove that the hospital’s failures to properly manage and assess the deceased person’s presentation caused the death. This is largely due to the difficulty in predicting human behaviour, especially where there is a history of previous suicide attempts. In providing their opinion on this vexed issue, medical experts must rely upon the particular person’s mental health history and treatment, their support structures, published literature and data on suicide rates, and their clinical experience. Each case turns on its own peculiar facts which makes the giving of legal advice to a person who has either survived such a suicide attempt with serious injuries or family members of the deceased a complex task.