Concern over psychiatric patients at risk in hospital

A patient takes their own life in Scotland's mental health hospitals nearly every five weeks on average, new figures show.

Researchers found the majority of these in-patients were assessed as being of low or no short-term risk before they died.

Families have raised concerns that not enough is being done to prevent some of the most vulnerable patients in the healthcare system from taking their own lives.

And BBC Scotland News can reveal the Health and Safety Executive (HSE) has issued improvement notices to three hospitals in recent years for failing to reduce the risks of patient suicides.

Warning: This article contains distressing content

The University of Manchester runs a research project which tracks suicide rates and safety trends for mental health patients across the UK.

Its latest report found that a total of 139 hospital mental health in-patients across Scotland are estimated to have died by taking their own life between 2012 and 2022.

According to the research, the majority (64%) of these people were assessed as being of low or no short-term risk before they died.

In 2022, there were 11 mental health in-patient suicides across Scotland, a rate of 5.9 suicides per 10,000 admissions.

This was up from eight suicides in 2019, a rate of 3.7 per 10,000 admissions.

Former psychiatrist Dr Sara MacRae was an in-patient at the Royal Edinburgh Psychiatric Hospital in 2020 when she killed herself in her room.

A Fatal Accident Inquiry (FAI) last year ruled staff missed a number of chances to prevent the death and there were "serious failings" in the treatment and care of Dr MacRae by NHS Lothian.

BBC Scotland News revealed Dr MacRae's room had been assessed as a "high risk" for suicide attempts the year before she took her own life but work to address this had been paused due to budget pressures.

Dr MacRae's son Christopher said: "The research shows a deeply concerning trend, yet sadly it is not surprising.

"FAIs are not mandatory following the death of a patient in psychiatric detention. In our case, we faced a four-year battle to secure an inquiry into my mum's death.

"In stark contrast, the Scottish Prison Service mandates a full inquiry after any death in custody, providing vital insights and lessons to prevent future tragedies.

"Given the continuing number of in-patient deaths, it's clear Scotland's health boards are not yet doing enough to prevent these tragedies."

A number of hospital deaths in recent years have led to investigations by the HSE.

NHS Highland was issued with three improvement notices by the watchdog in 2022 for its New Craigs mental health hospital in Inverness.

They all relate to the health and safety of patients and staff, including the failure to remove "identified ligature points from areas on the wards where patients may be isolated" such as bedrooms and en-suite bathrooms.

More than 8,000 ligature points have been identified in New Craigs, where three patients have taken their own lives in the last five years.

NHS Highland says work to remove these points, and make improvements at the hospital, is ongoing.

Elsewhere in the Highlands, an improvement notice issued last year to the Lorn and Islands Hospital in Oban for failing to adequately reduce the risk of patient suicides has now been complied with.

A HSE improvement notice was issued to Wishaw University Hospital last year for failing to adequately reduce the risk of patient suicides on its mental health ward.

When BBC Scotland News asked NHS Lanarkshire if the issues had been addressed, it said it was unable to comment as the matter is subject to ongoing legal proceedings.

The HSE also hit Forth Valley Royal Hospital in Larbert with an improvement notice last year relating to suicide risks in its mental health ward.

NHS Forth Valley board papers in January rated the issue as a high risk because "patients have come to harm / died and there is nothing to suggest they won't continue to do so".

The notice has now been complied with as part of a wider ongoing programme of work to reduce potential risks in a number of inpatient areas.

In 2018, a Scottish government review found the deaths of people being treated for a mental health condition or learning disability are currently not being investigated consistently in a way that can be guaranteed to be independent.

The review found that not all deaths are investigated, especially in cases where the deaths have not been recorded as unavoidable or unexpected.

Scottish ministers asked the Mental Welfare Commission for Scotland (MWCS) to develop a new system for investigating deaths but its recommendations have not yet been fully adopted.

A spokesperson for the commission said: "We absolutely agree the need for a consistent approach to support learning and the need to ensure that this happens."

A Scottish government spokesperson said: "Every death by suicide is a tragedy and our heartfelt sympathies go out to all those affected by suicide.

"Our suicide prevention strategy sets out an ambitious programme of work to prevent suicide, including in clinical settings.

"We are working with the MWCS to develop a new system of reviewing the deaths of people who died while detained under mental health legislation."

• If you've been affected by the issues in this story, help and support is available via the BBC Action Line.