Learning from critical incidents

Ian Clarke is a consultant in general adult psychiatry in the west of Glasgow (Arndale Resource Centre, 80–90 Kinfauns Drive, Drumchapel, Glasgow, G15 7TS, UK. Email: [email protected]). He is clinical lead for the Greater Glasgow and Clyde Patient Safety Group. He obtained a Masters in Business Administration in 2004 and is lead clinician for the west of Glasgow. Critical incidents in mental health generate many emotive issues. Despite the fact that the morbidity and mortality associated with mental illness are well-accepted, there is often a sense of failure associated with an outcome such as suicide or homicide. The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (Appleby et al, 2006) found that in over a quarter of suicides reported in the UK, the individuals had been involved with mental health services in the year prior to their death. At final contact, the risk of suicide had been deemed to be low or absent for 86% of these patients. Szmukler (2000) asks of homicide inquiries: ‘What sense do they make?’ He questions the logic behind them and raises the issue of the financial cost, the harm to staff, the distorting influence of the media and the reinforcing of stigma.