Research

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The Zito Partnership and Care Right Now (CIC) are undertaking research to understand what support and information people received following their experience of homicide committed by an individual who had been in contact with secondary and specialist mental health services in the previous 12 months.

We are grateful to Julian Hendy from HundredFamilies.org for assisting with this important piece of research.

Draft Research Proposal

Background and rationale for the proposed study

The question: ‘What support and information did you receive following your experience of homicide committed by an individual who had been in contact with secondary and specialist mental health services in the previous 12 months’

The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness examines suicide, and homicide committed by people who had been in contact with secondary and specialist mental health services in the previous 12 months (Univ. Manchester 2014). 

This study will complement the National Confidential Inquiry by examining the impact of homicide on the family and inform future guidance and policy to prevent secondary victimisation following a traumatic event.

The study will focus on the implementation of The NHS ‘Being Open’ guidance (NPSA 2009) and examine how NHS Trusts have created an open and honest environment and comprehensive support for the family in the aftermath of a death committed by individuals who had been in contact with secondary and specialist mental health services in the previous 12 months.

This study will explore:

  1. How multi agency services respond to the needs of those bereaved following a patient safety incident where the harm has been committed by people who had been in contact with secondary and specialist mental health services in the previous 12 months.

  1. What support and information is both available and relevant for families, with specific reference to incidents involving homicide committed by individuals who had been in contact with secondary and specialist mental health services in the previous 12 months.

  1. The experience of families who have been affected by homicide; illustrated by what helped and what did not help, and what can lead to the experience of secondary victimisation.

In addition this study will include analysis of the experiences of interviewees of support and information offered by the Police, Criminal Justice agencies and voluntary sector services.

Aims and objectives

To find out the support offered by multi agency to those bereaved through violent crime committed by individuals who had been in contact with secondary and specialist mental health services in the previous 12 months.Objectives:

  • To explore family experience of services; information and support and all other factors which they identify as having helped or hindered their progress, focusing on things that enabled them to cope and recover following their experience of violent crime

  • To highlight key issues

  • To compare findings with existing research and theories of engagement

  • To relate findings to NHS, Criminal Justice Agencies and Voluntary Sector Service; to influence commissioning and policy development and practice.

Plan of Investigation

The study will use themed content analysis, in order to analyse key issues in engagement as identified by individuals and families affected by violent crime; relating information, support and services offered.Design of study

  1. To interview 30 individuals affected by homicide committed by individuals who had been in contact with secondary and specialist mental health services in the previous 12 months. This research will also include family experience of inter family homicide.

  2. Using a semi-structured format; asking interviewees what were the factors which helped them cope and recover and what hindered this process.

  3. The study will report only on issues identified in the interviews.

Sample

Potential study candidates to be identified by hundredfamilies.org (Practical information for families affected by mental health homicides in Britain; Evidence-based analysis, resources and information for mental health professionals; Free access to the largest collection of homicide independent inquiry reports on the web)hundredfamilies.org will approach the family members if they would like to participate and pass on written information on the study, prior to the interviews being arranged.

The study will be carried out anonymously.

A range of methods of contact will be outlined on the information sheet. The interviews will be conducted in the location chosen by the family member.

Inclusion criteria:

  1. Age 18 +.

  2. Has cognitive ability to participate

  3. Has experienced homicide of a family member committed by an individual who had been in contact with secondary and specialist mental health services in the previous 12 months.

Criteria for exclusion:

  1. Does not have the mental capacity to participate

  2. Does not have sufficient cognitive ability to participate

  3. Cannot speak English

  4. Safety concerns in relation to the researcher

  5. Safety concerns in relation to the interviewee

  6. Although the incident is reported as an NHS Patient Safety Incident the definition of ‘services’ that helped is not restricted to the NHS and includes any sector and could be from any source e.g. Housing; Support Groups; Police; Victim Support ; Voluntary Sector Services; Coroner etc.

Ethical & legal issues

The following will be taken into consideration and included in risk management plan:

  • Capacity and Consent (all parties)

  • Data Protection

  • Maintaining confidentiality and anonymity

  • Home interviews (place chosen by interviewee) – Interview at home / Lone Worker policy be implemented

  • Self-harm or suicide risk – need to arrange support for the interviewees and to explain that confidentiality may be breached if a serious risk is exposed

  • Possibility of disclosure of past trauma – need to arrange support for the interviewees

  • Opt out arrangements (before, during or after the interviews)–and use of collected information collected prior to the opt out

  • Participating organisations need to be aware that highlighting poor practice, or poor service provision, is a possibility

Methods of data collection

1. One to one recorded interviews with family members in a location of their choice lasting a maximum of 1.5 hours. The interviews will be recorded.

2. Each interviewee will be asked how they want to find out the results of the study.

All interviewees will be offered a copy of the final report (or summary / easy read version if they prefer).

Data analysis

The recorded interviews will be transcribed verbatim, including notes on pauses and emphasis. Following this they will be analysed and coded.As part of this generic approach every effort will be made to code the data as an outsider, without using theories or pre-knowledge (Foss & Waters 2003). A sample of the transcripts will be separately coded and reviewed by an uninvolved person, in order to help validate the analysis.

Potential benefits of this study

Possible outcomes:

  • Recommendations for approaches to information and support offered to families who have experienced homicide committed by people who had been in contact with secondary and specialist mental health services in the previous 12 months

  • Recommendations for training and education

  • Highlighting best practice

  • Contribution to the evidence base

  • Recommendations for further study

  • Recommendations for service structures

  • Recommendations for teamwork and leadership

  • National presentation

  • Feedback to NHS England

  • Feedback at local level support groups providers and commissioners

  • Publication in an academic journal

  1. Timetable of proposed study — to be completed

References:

Centre for Mental Health and RiskWWW: http://www.bbmh.manchester.ac.uk/cmhr/research/centreforsuicideprevention/nci/ (accessed 17/12/14)

Department of Health (1999) Safer services: national confidential inquiry into suicide and homicide by people with mental illness.WWW: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4005479 (accessed 17/12/14)

Flynn, S ; Hunt, IM ; Robinson, J ; Swinson, N ; Meehan, J ; Bickley, H ; Parsons, R ; Burns, J ; Shaw, J ; Kapur, N ; Appleby, L (2004)Homicide by people with mental illness: A national clinical surveyEuropean Psychiatry, 2004 Apr, Vol.19 Suppl 1, pp.189S-189S

Foss, S.K., and Waters, W. (2003) Coding & Analysis of Qualitative Data WWW: http://www.abdsurvivalguide.com/News/020603.htm(accessed 17/12/14)

John Gunn, Pamela Taylor (2014) Victims and Survivors Forensic Psychiatry: Clinical, Legal and Ethical Issues, Second Edition 2014. Chapter 28 CR Press Taylor and Francis Group

Ministry of Justice Victims Services (May 2013) Commissioning Framework.WWW: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/203979/victims-services-commissioning-framework.pdf (accessed 17/12/14)

National Patient Safety Agency [NPSA] (2009) Being Open; Communicating patient safety incidents with patients carers and their families: NPSA/2009/PSA003 WWW: http://www.nrls.npsa.nhs.uk/resources/?entryid45=65077 (accessed 17/12/14)

National Patient Safety Agency[NPSA] (2004) ‘Seven Steps to Patient Safety’’ WWW: http://www.nrls.npsa.nhs.uk/resources/collections/seven-steps-to-patient-safety/ (accessed 17/12/14)

NHS England (2014) The Never Events List; 2013/14 update. NHS England, Patient Safety Domain Team. 12 December 2013. WWW: http://www.england.nhs.uk/wp-content/uploads/2013/12/nev-ev-list-1314-clar.pdf (accessed 17/12/14)

Pinto A, Faiz O, Vincent C. (2012) Managing the after effects of serious patient safety incidents in the NHS: an online survey study. BMJ Quality & Safety. 2012; 21(12):1001-8.

Swinson, N. ; Ashim, B. ; Windfuhr, K. ; Kapur, N. ; Appleby, L. ; Shaw, J. (2007)National Confidential Inquiry into Suicide and Homicide by People with Mental Illness: new directionsPsychiatric Bulletin, 2007, Vol.31(5), pp.161-163

University of Manchester (July 2014) National Confidential Inquiry into Suicide and Homicide by People with Mental Illness: Annual Report 2014 – England, Northern Ireland, Scotland and WalesWWW: http://www.bbmh.manchester.ac.uk/cmhr/centreforsuicideprevention/nci/reports/Annualreport2014.pdf (accessed 17/12/14)

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