This section provides you with specific extra information about the investigation of deaths of psychiatric patients, who are either detained under the Mental Health Act 1983, informal patients admitted to hospital or community patients living independently or semi-independently in the community. You should read this section with the general sections in the guide.
Will there always be an inquest when someone dies whilst detained under the Mental Health Act?
Usually. If a person dies an unnatural death or dies unexpectedly (including by suicide) whilst detained under the Mental Health Act there will normally be an inquest. At the moment, there is no automatic obligation for a coroner to hold an inquest in these circumstances. The position is different if the patient was an informal patient or a community patient (see below).
Will the inquest be held with a jury?
At the moment it is up to the coroner to decide whether to call a jury when an inquest is held into the death of a person who was detained under the Mental Health Act.
What if the deceased person was a community psychiatric patient?
If your relative was under the care of a Community Mental Health Team when he or she died, or was an informal patient in hospital, there may be an inquest. You should find out if there is to be an inquest within a few days of the death. If there is no inquest and this is something that you are worried about, you should contact INQUEST or an experienced solicitor for advice.
Should I contact INQUEST or any other organisation?
Yes, you can contact INQUEST for specialist advice about the inquest process. It may also be helpful to contact the mental health organisations Mind or Rethink.
Will there be a post-mortem?
Usually and if so, it is usual practice that this is carried out immediately, although the final post-mortem report sometimes takes a while to be produced. The pathologist will normally produce an interim post-mortem shortly after the death following his or her examination, but this will not usually contain the results of toxicology and histology testing if this has been done, and it is therefore incomplete. Toxicology testing is explained in further detail below. Histology is testing tissue samples to understand whether the person who died suffered from any diseases. These tests take more time, and there is sometimes a wait of several weeks before the final post-mortem report is disclosed to the family.
The post-mortem will be carried out by a Home Office pathologist. If you have any concerns about the way in which a person died, then you may wish to be represented at the post-mortem itself, or consider obtaining a second post-mortem (see Section 2.2 for more detailed information about post-mortems). This can often be important in cases involving restraint or the use of force.
What are toxicology tests?
A toxicology report is a report completed when a person’s blood and urine has been tested for the presence of recreational and prescription drugs (including alcohol). These tests are normally carried out by a specialist toxicologist, but are then taken into account in the final post-mortem report when the pathologist gives a cause of death. Toxicology testing can be particularly important in the deaths of psychiatric patients, especially if there are concerns about whether a person’s medication played a part in their death.
It is often the case that toxicologists are not asked to test for specific prescription drugs. Therefore, if you are concerned and the cause of death is not immediately apparent, you may wish to ask the coroner to ensure that the toxicologist tests for the specific drugs that the deceased was being prescribed at the time of his or her death.
Blood and urine samples are needed to carry out toxicology tests. These samples can often be destroyed shortly after death so if this is something you are worried about, you may need to ask the coroner as soon as possible to ensure that the samples are kept so that you can seek advice and possibly get a second opinion.
Should I contact a solicitor?
In most cases, yes. It can really help you play a part in the inquest process. You should contact INQUEST who will either work with your own solicitor or put you in touch with a solicitor in your area who has relevant expertise.
Your solicitor should take a detailed statement from you about what you know about the circumstances of the death. If you do not have a solicitor it is a good idea to write down what you remember as soon as possible so that this can be used as part of the inquest. Your solicitor should request a copy of the medical records from the Mental Health Trust and make contact with the Trust to find out whether an internal investigation will take place and to ensure that you can be involved if you want to be.
Will the Hospital Trust do its own investigation?
Yes. Usually if a person dies whilst an inpatient under the care of a Mental Health Trust or is a detained patient on extended leave, that Trust should carry out an internal investigation into the death in order to find out what happened and if lessons can be learned. These investigations are usually called Serious Untoward Incident Investigations or a Critical Incident Reviews, but they vary a lot from Trust to Trust.
Internal investigations for non-detained patients, both those in hospital and in the community, will vary depending on the circumstances of the death. If the person who died was detained under the Mental Health Act, a Trust will tend to investigate in more depth and more thoroughly than following the death of a non-detained patient. In order to be effective, Trusts should carry out investigations into the deaths of detained patients reasonably speedily, with a degree of independence and with the involvement of the family of the person who died. The Hospital Trust should normally arrange to meet the family during the investigation in order to identify any concerns that the family has and to explain the investigation process.
How long does the investigation take?
Each Trust should have a policy explaining how it investigates the death of patients under their care, how long the process should take and what steps are involved. You have the right to see a copy of this policy, which varies from Trust to Trust.
What information will I be given during the investigation?
You should receive updates regarding the progress of the investigation from time to time. Once the investigation is complete, you should receive a copy of the investigation report along with any recommendations which have been made. Sometimes Trusts will not finalise a report until the coroner’s investigation is complete, if an inquest is to be held.
If you are not informed by the Hospital Trust that they will be making an investigation, you should contact them to find out what steps they are taking. If you are not happy with the Trust’s investigation or the report, you may wish to take further action and should contact INQUEST or a specialist solicitor.
Can I use documents from the Trust investigation for campaigning or talking to the media before the inquest?
This is something that you should discuss with your solicitor or INQUEST before talking to the media. You or your solicitor may have signed an undertaking of confidentiality which means that only you, your family and legal advisors can see the documents and they can only be used for preparing for the inquest.
What are the outcomes of the Trust investigations?
Trust investigation reports will sometimes include recommendations which can cover a wide range of issues. The purpose of these investigations is to learn lessons for the future and improve unsafe practices within the relevant Trust. As such, recommendations can include reviews of policy, training for staff, changes in practices and procedures and even disciplinary action against members of staff.
Usually the Trust will review the report and the evidence heard on the conclusion of the inquest and consider if any further action should be taken. At that point the report is usually finalised.
Who will be represented at the inquest?
The family of a psychiatric patient have the right to be represented at the inquest, as with all inquests. In addition, the Hospital Trust itself is usually legally represented. Sometimes more than one Trust will be involved in the provision of care, and so it is possible to have more than one Trust represented at the inquest. Sometimes individual members of staff from the Hospital Trust will have separate legal representation as well.
Can I get funding for legal representation at the inquest?
It may be possible to obtain legal aid for preparation for and representation at the inquest. The funding system for inquests is unique and complex (see Section 3.1).
After the inquest
See Section 4.4: After the inquest.
After the inquest, there may be a number of matters which you may wish to consider:
- • If you have concerns about the care and treatment that the deceased received and/or the Trust’s own internal investigation, you may wish to make a formal complaint to the Trust regarding this. The Trust will have a duty to investigate your complaint and respond to the matters that you raise.
• You may also wish to make a complaint to the Care Quality Commission (CQC), which is the independent regulator of health and social care in England and Wales. In particular, the CQC protects the rights of people detained under the Mental Health Act and keeps a record of people who have died whilst detained.
• You may wish to seek advice on whether you have a civil claim arising out of the death of your relative.
• You may wish to contact your MP and/or the media.
You can discuss these options with your solicitor and INQUEST.
