Coping with a coroner's inquest: a psychiatrist's guide

After a patient dies by suicide: an illustrative case for trainee psychiatrists and trainers

One of the most challenging experiences psychiatrists will face in their careers may well be the death of a patient by suicide. This is likely to happen at least once during a psychiatrist's career, and often more. It can be an intensely complex and painful event with a wide range of emotional responses. Reflecting on the death and accessing good support helps clinicians process the emotional impact. It can also increase their resilience in the longer term by giving them a greater understanding of both their own and their patients' limitations, and in this way strengthen their capacity for compassion as clinicians. Using an illustrative case study, this article provides an insight into the experience of losing a patient to suicide and signposts to sources of support.

Reform of the coroners' service in England and Wales: policy-making and politics

The Coroners and Justice Act 2009 promised an overhaul of the coroners' service, introducing much needed efficiencies to benefit people bereaved by suicide and other sudden deaths. Central to these reforms was the introduction of a Chief Coroner to coordinate the system and exercise wider public health responsibilities. The coalition government's proposal to abolish the Chief Coroner's office on grounds of cost, ignoring the potential efficiency gains, has delayed implementation of coronial reforms significantly. With this proposal now abandoned, ministers are expected to appoint an independent Chief Coroner in early 2012. This article describes the intended benefits of the reforms for bereaved relatives, coroners' staff, public sector budgets, and the public health, and explores the reasons behind the delays.

Coping with suicide: a perspective from Scotland

Procedures following suicide differ in Scotland from elsewhere in the UK and we describe the investigation of deaths by procurators fiscal and fatal accident inquiries that may ensue. Higher Scottish suicide rates, and possible reasons for these, are mentioned. Suicide risk cannot be accurately quantified in individual patients but psychiatrists should take the view that good management can collectively reduce the risk among all patients. We comment on practical and emotional issues for clinicians who are coping with the suicide of a patient.

Cross examination of clinicians at coroners' inquests following deaths in custody

PURPOSE

This article draws upon the international literature to focus on the investigation of prisoner deaths in England and Wales, concentrating on clinician involvement in this process.

DESIGN/METHODOLOGY/APPROACH

This is a viewpoint paper regarding clinician involvement in coroner investigations of prisoner deaths in England and Wales.

FINDINGS

Compared to colleagues practising in the community, the authors suggest that there is a higher burden of investigation upon clinicians practicing in secure environments and recommend improved training for prison clinicians regarding expectations of the coroner's inquest and also a system whereby questioning in coroners' courts is directed through the coroner.

ORIGINALITY/VALUE

This paper provides an updated perspective on the issue of coroner investigations following a death in prison custody, from the position of practising prison clinicians.