The parents of the victims of the awful tragedy in Nottingham have every sympathy from all sections of the population (‘It’s a vortex of hell’: fathers of Nottingham students stabbed to death on trying to find answers, 11 March). I don’t work for the mental health trust in question, but I do think that by highlighting shortcomings in services and care, the parents are putting a spotlight on the tragic circumstances that led to the death of their children. But some of the demands need to be carefully deliberated on.
Certainly we should think about whether it is appropriate to discharge a certain group of patients with serious mental illness from mental health services to primary care. Doing so is a policy that I have never agreed with because, as I see it, it fails both the patient and society.
But the fathers’ demand that psychiatrists should be criminally accountable for patients they discharge needs to be thought about carefully. As a society, we need to be honest about the difficulties we are facing. Psychiatrists are under pressure to discharge patients that is not of their own making. Difficult issues underlie this, such as an increase in demand, underresourced services, the politicisation of mental health services, perverse incentives and sometimes, of course, failures in clinical assessment and care.
I, and I am sure most of my colleagues in the UK, have had difficult conversations when pressure is brought to bear to discharge patients inappropriately. If we do not do this, sometimes one gets “othered” or seen as a difficult clinician. This is a multifaceted problem, which the criminalisation of psychiatrists will only exacerbate. If psychiatrists face going to prison for factors beyond their control, we will have fewer, not more, psychiatrists.
Dr Musa Sami
Consultant psychiatrist, Nottingham
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