Defensive Psychiatry, Reality or Mirage?
Serious Untoward Incidents, or Sentinel Events, are adverse incidents such as homicide, suicide, serious self-harm or assault, which usually result in an official investigation or inquiry. The emphasis and publicity for such events is often blamed for encouraging defensive practice: the over restriction of patients to promote safety and an emphasis on risk assessment outweighing treatment considerations. The Tompkins Acute Ward Study is a longitudinal qualitative and quantitative study of 13 acute psychiatric wards and 3 psychiatric intensive care units in London UK. The data collection is ongoing, however so far more than three years of official data, 120 staff interviews and 76 patient interviews have been collected and conducted. Quantitative analysis of 69 Serious Untoward Incidents has revealed that organisational or systems factors have a significant role in precipitating such events. A longitudinal analysis of the impact of one of those incidents (a homicide) revealed that it caused staff to leave their jobs, but no increase in defensive practice. However interviews of staff showed that previous Serious Untoward incidents were perceived to impact on practice and had an emotional impact lasting many years. Some responses to such incidents can be beneficial and helpful, others may not be. Best practice in the light of these findings will be described.