Sunday, 17 March 2013

Mental Health Homicides - Apportioning Blame

Like everyone else, I have been appalled by two recent murder cases: that of grandmother Sally Hodkin in Bexleyheath, 2011, and the fatal stabbing of 16-year old Christina Edkins on a rush hour bus in Birmingham on the 7th March this year. These sickening murders have called into question the safety of the general public from mental health patients at large in the community. This is because the perpetrators of both these murders have been people with mental health issues. Sally Hodkin was killed on the street by Nicola Edgington, who had previously been incarcerated for the murder of her mother. The man arrested for the killing of Christina Edkins, 22 year old Philip Simelane, has been remanded in custody to a secure mental health unit. Now, it is very difficult to get accurate figures for such murders, as they do not seem to be compiled by a disinterested body. Julian Hendy, whose own father was murdered in a Bristol street by a mental health patient in 2007, says that there have been about 900 such murders since 1993. As he says:
"We are frequently told that such killings are “rare”, with the implication that we shouldn’t worry too much about them – but plane crashes are rare and when they do happen, like mental health homicides, they are always catastrophic. And I don’t think such killings actually are that rare. So far I have documented around 900 mental health homicides in Britain since 1993 and I have collected some 300 official investigations and inquiry reports. The picture that emerges is of a mental health service that struggles to deal with people with serious mental illness and that often does not do things as effectively as it should."
Interestingly, the tabloid press do not seem to be blaming the mental health authorities for these terrible events as much as they blame the police. Nor is it just the tabloids; in  a rare example of unity, the Guardian and the Daily Mail both have condemned the police for their failure to stop Edgington at an earlier stage. Like Julian Hendy, I believe this to be unfair. When all is said and done, it is the mental health mandarins who release these individuals into the community, and it is they who should be held to account. But it may go deeper than that - as in all NHS issues, there is an issue of resources and political will. As two psychiatrists have commented :
"Because the media only become interested in mental health care when fatalities are involved, this drives Government policy. As a result of over-emphasising the link between mental illness and dangerousness, there is a concentration on treating a small number of offenders in secure hospitals. This costs £1billion per year - 15% of the total NHS investment in the mental health of working-age adults.
The number of standard NHS psychiatric beds has gone down by 60% in the last two decades, while the number of involuntary admissions has gone up by 60%. In other words, it is increasingly difficult to gain access to psychiatric care when acutely unwell." And, as they point out, Nicola Erdington was a voluntary patient - she was trying to be admitted to a unit on the day she carried out her second murder.
As I do not have the answer to this problem, not being a mental health professional, I will not try to offer a solution. More information on this issue can be found at the website started by Julian Hendy.
 I can, however, offer an historical perspective. The right-wing press, interestingly enough, never point out that "care in the community", as it is known, was a Tory initiative, put into place by the Thatcher government in the 1980s. It was brought about by a strange alliance of mental health charities, who wished to end the stigmatisation of mental health patients by closing down the large and forbidding asylums and Tory monetarists, who wanted to cut back on public spending. The blame for the present tragic and muddled situation which led to the 900 murders mentioned here can be laid at the door of Mrs Thatcher and her merry band of vegetables (aka "The Cabinet"). Ian Duncan Smith, the ex-Tory leader, now describes Care in the Community as a "£100bn failure". Well, he should know...