There has been increased scrutiny and focus in the community and the media on instances of self-harm and harm to others, perpetrated by people who have either been recently released from a psychiatric facility or have been refused treatment in a psychiatric facility.

1. Welcome
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2. © 2016
Adverse outcomes following
detention in a Psychiatric Hospital –
a review of recent cases
20 June 2018
Presented by: Catherine Henry

3. 1. Discussion of recent cases
2. Correlation v causation:
do mental health facilities increase suicide risk?
Outline

4. Recent tragedy
o Stabbing of five-year-old boy by allegedly
mentally ill father on 7 June 2018
o Father sought voluntary admission to Hornsby
hospital 2 days before
o Was not admitted due to lack of beds

5. Liability of health care workers
and psychiatrists for harm

6. Hunter and New England Local Health District v McKenna (2014) 314 ALR 505
o Changed scope of the duty of care that psychiatric hospitals owe to the public
o Facts
 release of a mentally ill man, Mr Pettigrove into the care of his friend, Mr Rose
 Mr Rose planned to drive Mr Pettigrove back to his home in Victoria
 Mr Pettigrove killed Mr Rose on the journey home
 Mr Rose’s family sued HNELHD
 Decision
 High Court held an obligation created by the Mental Health Act (NSW) 2007 of the
least restrictive care in the least restrictive environment was inconsistent with the
common law duty of care
 Since the HNEHD did not owe a duty of care to Mr Rose’s family, they were not
responsible for the loss the family had suffered

7. Hunter Area Health Service and Anor v Presland (2005) 63 NSWLR 22
 Facts
 Mr Presland killed his brother’s fiancé six hours after being discharged from a psychiatric
hospital
 Mr Presland acquitted of murder due to his mental illness
 But detained in a forensic psychiatric ward
 Mr Presland sued the hospital and the psychiatrist
 Argued if he had not been discharged, the harm to himself and others would have been
avoided
 Decision
 Supreme Court awarded Mr Presland damages
 Overturned on appeal
 Amendments made to legislation
 Civil Liability Act (2002) NSW changed after this decision
 People who commit unlawful acts amounting to a serious offence not compensated for any
non-economic loss and economic loss

8. Smith v Pennington [2015] NSWSC 1168
 Facts
 Mr Smith granted four days home leave from a mental health unit
 Attempted suicide during that time
 Mr Smith sued for failing to warn parents about key stressors
 Decision
 NSW Supreme Court accepted that there had been a breach of duty of care
 BUT they did not accept that the breach caused the suicide
 His Honour, Garling J held that even if parents had been warned,
they would not have been able to prevent his suicide

9. Parents as plaintiffs
o Cases in the Hunter region ….

10. Case A - Failure to admit suicidal patient
• Young man suicided after release from a mental health facility
• His condition deteriorated at home
• Parents pleaded for him to be readmitted
• Hospital refused
• Parents sued the hospital
• Case settled out of court

11. Case B - Failure to provide adequate supervision
• Young man suicided at a psychiatric hospital.
• History of self-harm and substance abuse.
• Expressed suicidal thoughts to the staff and other patients.
• Found dead in the hospital.
• Parents sued the hospital.
• Case was settled out of court.

12. Case C - Patient left with catastrophic injuries
• Young woman suffered catastrophic injuries during a suicide attempt
• She was a patient at a psychiatric hospital due to being a high suicide
risk
• Allowed to take an unsupervised walk where she attempted suicide
• Suicide attempt unsuccessful
• Left with catastrophic injuries
• The case was settled out of court

13. What can we draw from these cases?
o Strong association between scheduled psychiatric patients
AND
o Increased risk of suicide and attempted suicide
Prevention?
o Need to address chronic shortage of beds in mental health wards
(esp. in regional areas)
o More acute beds = reduce the risk
o Admit people in crisis on a needs NOT a resource basis

14. Can psychiatric hospitals make things worse?
Controversially, Professor Matthew Large argues:
o psychiatric units themselves cause an increased risk of suicide
o being detained in a psychiatric hospital is traumatic
o suicide in hospital or shortly after is linked to the experience of
psychiatric patients within the facility itself
(Matthew Michael Large and Nav Kapur, ‘Psychiatric hospitalisation and the risk of suicide’ (2018) 212
The British Journal of Psychiatry 269–273)

15. [H]ospital treatment can be perceived as humiliating, stigmatising,
coercive and traumatic. Hospitalisation often results in a loss of
social support and social role, and violent victimisation is
frighteningly common. In-patients who are already vulnerable are
likely to be particularly susceptible to these factors, which are known
to be associated with suicide
(Matthew Michael Large and Nav Kapur, ‘Psychiatric hospitalisation and the risk of suicide’ (2018) 212
The British Journal of Psychiatry 269-273)

16. correlation v causation
Professor Kapur argues:
o Correlation between detention in a psychiatric hospital
and suicide upon release does NOT = causation
o Person admitted to a psychiatric facility because they
need protection from serious harm to himself or herself or
other people (per Mental Health Act 2007 (NSW))
o So, psychiatric patients have higher risk of suicide than
general population despite experiences in a psychiatric
facility.

17. Professor Large responds…
• acknowledges relationship between psychiatric
hospitalisation and fact person there because of
suicidal thoughts
• But this does not explain large variances in suicide
rates of different psychiatric hospitals
• Higher suicide rates in certain hospitals point to
psychiatric facilities themselves playing a role

18. Conclusions of Large and Kapur
Professor Large:
• poor quality care and unsafe psychiatric hospitals exacerbate
suicidal tendencies of an already suicidal person rather than
reduce them
Professor Kapur:
• psychiatric hospitals prevent rather than cause self harm and
suicide
• but variations in the quality of some hospitals might mean that
patients receive ‘less-than –ideal care’

19. Our View
• Disagree with Professor Large’s that admission to psychiatric
hospital increases suicide risk of a person upon discharge.
• But agree that poorly run and under-funded psychiatric facilities
providing ‘less-than –ideal care’ can increase the risk
• Facilities with a spike in patients and ex-patients suiciding require
urgent review

20. Questions?
www.catherinehenrylawyers.com.au