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Serious incident inquiries have a role

Homerton Hospital, Homerton Row, London E9 6SR

Sir: the irrationalities identified by Szmukler (Psychiatric Bulletin, January 2000, 24, 6-10) suggest that serious incident inquiries serve a role well beyond the need to explain how - or even why - something ‘untoward’ happens. Inquiries are, in fact, attempting to answer questions about fear, stigma, morality and personal responsibility, areas where rational inquiry has a poor record of satisfactory results. The folly of applying rational tools to irrational material becomes clearer when one considers the different perspectives and expectations of the agencies involved. To psychiatrists, inquiries are a quasi-legal form of local service audit, with powers to drive change far in excess of what may rationally be expected from a single case study. For the bereaved they serve a propitiatory role, the inquiry process helping families to make sense of the powerful emotions that accompany homicide. To the public at large, they provide a superficial way to soothe a fear that has troubled us since antiquity, and even more so in our individualistic, comfort-driven culture: ‘it could happen to me for no reason’. The idea of a ‘methodical’ investigation of the causes of such a natural but irrational fear renders it more manageable. To the Government, inquiries into the minutiae of local service provision provide welcome distraction from the simple fact that the psychiatric services generally have always been neglected.

The common theme of these irrationalities is the fear of mental illness. Many have suggested solutions to the problems of inquiries themselves (Eastman, 1996; Buchanan, 1999), but until we address the stigma-driven emotional responses that propel the current serious incident culture, or at least attempt to identify them, it seems that all shall lose and none shall have prizes.

References

BUCHANAN, A. (1999) Independent enquiries into homicide. British Medical Journal, 318, 1089-1090.[Free Full Text]

EASTMAN, N. (1996) Enquiry into homicides by psychiatric patients; systematic audit should replace mandatory enquiries. British Medical Journal, 313, 1060-1067.

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