Unexpected deaths could reach new heights in mental health care

The tragic saga of patients dying unexpectedly at the region's mental health trust continues after it emerged the number of deaths could reach new heights this year.

Latest statistics from Norfolk and Suffolk NHS Foundation Trust (NSFT) show 140 patients suffered 'unexpected deaths' from April to December last year – the equivalent of three quarters of the 2016/17 financial year.

During the whole of the 2015/16 financial year 158 patients died unexpectedly.

An unexpected death is classed as one where the cause could not be anticipated. It can be suicide, natural causes, a physical illness or an accident and includes anyone who has been treated by the trust in the six months before their death.

The news comes on the day the BBC devotes an episode of its flagship investigations programme 'Panorama' to mental healthcare in the NHS.

The NSFT is expected to feature in the programme.

Mental health campaigners have voiced concern about the sharp rise in unexpected deaths at the trust in the last two years.

In 2012/13 53 patients died, but within three years that number rose to 158 – and this year the number is likely to be even higher.

A spokesman for Save Mental Health Services in Norfolk and Suffolk said: 'The NSFT Board and commissioners have consistently disregarded legitimate public concern and refused to share information or investigate the causes of the increases properly.

'Instead lame excuses have been thrown around like confetti without proper analysis and facts are withheld from the public.

'The shoulder-shrugging and excuses have gone on for too long.

'Too many people have died.

'NSFT and commissioners must make the urgent reduction of the number of unexpected deaths their number-one priority.'

Dr Jane Sayer, director of nursing, quality, and patient safety, said: 'One single avoidable death is one too many.

'And we must remember that behind these 'figures' there are grieving families and friends, and staff who have done their very best to care for them.

'Unexpected death does not mean suicide, nor does it mean any mental health care or support was necessarily lacking, or that a death could have been avoided.

'A full review of our suicide figures shows that they have remained stable over the past four years with no specific increase or decrease, since 2012, even with fluctuations in numbers of unexpected deaths.

'Following a deep dive into mortality rates at NSFT, in line with national guidelines, the evidence appears to show us that over a third of all deaths were due to natural or physical causes, or are accidental deaths.

'A further 13pc were due to overdose, but it is not yet known how many of these were due to accidental overdose. In relation to cases where the cause of death has been confirmed as an overdose, for example, it remains for the Coroner to ascertain whether it was accidental or a person has taken their own life.

'The mortality review looked at all deaths of any person who has been in the care of NSFT up to 12 months after discharge, in the period between April 2016 and January 2017. (Serious Incident (SI) processes consider unexpected deaths up to 6 months after discharge.)

'Many of these deaths are still awaiting Coroner's investigation, and a further 38% of all deaths have causes as yet unconfirmed. This can be due to ongoing investigations into the cause of the deaths, for example.

'12% of all deaths recorded by NSFT within this same period of time appear to be cases of people taking their own life. But again, we remain cautious as Coroner investigations may need to take place, or are underway.

'In the five years since 2012 we have continued to see more and more patients, year-on-year as demand rises for support, and as we have also expanded our services and taken on new services.

'Last year (2015-16), for example, we saw 22,000 more patients than we did in 2012-13.

'An increase in the number of people a trust sees, and the complexity of their mental health conditions or potential of high risk lifestyles, means an increase in the number of deaths it is likely to report.

'However, last year we commissioned the independent Verita investigation into unexpected deaths and serious incidents at our Trust as we wanted further reassurance that our services are as safe as they can possibly be.

'We were reassured by Verita's findings, which reflect that we are a Trust which is a high reporter of serious incidents, because we have an open reporting culture, and that we do investigate to ensure any learning from any death, avoidable or otherwise, is taken on board. It is recognised that organisations with high levels of reporting are generally safer organisations.

'Although there are no national figures to effectively compare trusts, like for like, Verita said it did not appear that NSFT was an outlier in terms of high numbers of deaths or incidents.'

When asked what measures the NSFT has put in place to reduce the number of unexpected deaths, Dr Sayer said: 'We have introduced our FACT model where teams identify service users at particular risk in the community and should they go into crisis we can then quickly send in additional support.

'We are developing a single point of access into our CAMHS services to improve access for young people to help avoid crisis. Our eating disorders services have been expanded, and access to CAMHS crisis support in Norfolk and Waveney has been extended.

'We are expanding early intervention in psychosis services to try and manage any risk in that area; we are working in every A&E department in Norfolk and Suffolk to try and assist people - with whom we may not have had contact before - when they are in crisis and refer them to our support.

'We are working closely with the police and the criminal justice systems in both counties to try and get vulnerable people any mental support they need as quickly and easily as possible, as well as developing specialist services for veterans suffering from PTSD and therefore at increased risk of harm.'

Panorama will be broadcast on BBC 1 tonight at 8.30pm.

Have you got a health story for the EDP? Email nicholas.carding@archant.co.uk