FOI Ref: FOI/2022/4679
You asked
I would like information on deaths of individuals receiving treatment at in-patient mental health facilities.
For the following time periods, please provide statistical information relating to patients who died whilst receiving in patient treatment in a mental health facility:
- 2021-22
- 2020-21
- 2019-20
- 2018-19
- 2017-18
- 2016-17
- 2015-16
- 2014-15
- 2013-14
- 2012-13
- Total for the 10-year period
Please include information on all patients i.e. informal patients as well as patients detained under the Mental Health Act.
If it is possible to disaggregate this by informal/detained patients then please do.
1. How many White, BAME, and those who's ethnicity is not known patients who died in mental health facilities died:
a) From self-inflicted causes
b) From natural causes
c) During or after being restrained by medical staff or police called to assist medical staff
d) During or after seclusion or segregation
2. Of the BAME patients who died from self-inflicted causes, natural causes, those who died during or after being restrained by medical staff or police called to assist medical staff, and those who died during or after seclusion or segregation, please state who were:
a) Black
b) Asian
c) Mixed ethnicity. Where possible please break this down into:
(i) Mixed White/Black
(ii) Mixed White/Asian
d) Other ethnicity
We said
Thank you for your request.
Our mortality data is derived from information collected at the point of death registration. Whilst we receive information on the cause of death, we do not receive information regarding the circumstances of the death.
We also do not receive information on whether the deceased was detained under the Mental Health Act or an outpatient as this is also not recorded as part of the death registration process.
Therefore, we do not hold data relating to deaths after seclusion or segregation during mental health treatment, or deaths of those who are detained under the Mental Health Act.
In order to fulfil the remainder of your request, we would be required to create new information, involving a high level of statistical skill and judgement. Complex statistical skill would be required to link a number of datasets, as ethnicity is not recorded on the death certificate. Therefore, we would be required to link our Census information with mortality data to determine the ethnicity of the deceased.
Statistical judgement would also need to be applied to determine what mortality records would fall under categories of death by 'restraint' and 'natural causes, as well as records showing the place of death in a 'mental health facility'.
Public authorities are not obliged to create new information in order to respond to FOI requests. This information is therefore not held for FOI purposes.
Furthermore, even if we were to create this information, it would be unlikely that we could disclose the exact information requested. The number of variables involved would produce very low figures, making the risk of identification of individuals high. Disclosure of this information would be very likely to breach our Policy on protecting confidentiality in tables of birth and death statistics, as well as Section 39 of the Statistics and Registration Service Act 2007 (SRSA).
However, you may be able to procure something similar to this information via our bespoke services route. Such services are subject to legal frameworks, disclosure control, resources and agreement to costs under the ONS Charging policy. Please contact the Health Analysis and Pandemic Insight (HAPI) Customer Services team on Health.Data@ons.gov.uk to discuss this further.
We also would suggest contacting individual NHS trusts regarding your request, as they may already publish this information as part of their Learning from deaths in the NHS dashboard.
NHS Digital also publish a Mental Health Monthly Dashboard and Mental Health Act Statistics, Annual Figures - 2020-21. NHS Digital can be contacted on enquiries@nhsdigital.nhs.uk
In case it is helpful, our Health Data team have provided the following explanation of why some terms in your request are difficult to define. These points can be discussed further as part of the consultation process when requesting bespoke services, should you wish to take this route.
We require further clarification on the classification of a "mental health facility". We use a "communal establishment file" to identify the place of death. As there are mental health units within hospitals and prisons, the place of death would be the name of the Prison/Hospital and not specifically described as a "Mental Health Facility". There is no option for us to select Mental Health Facility as a place of death.
We require clarity on the term "restraint", as this would involve conclusions given by the coroner as to what ICD-10 code was applied in this case. For example, if the text contained words of restrained, restraint, held down, or words similar to these then we would allocate W64 and T733 against what the manner of death could be depending on the Conclusion as given by the coroner. If the death mentioned that the deceased were pushed etc. by bodily force, a Y04 ICD-10 code would be applied and the Manner of death is either "003 murder," "013 other assault (unlawfully killed (other))" or "O23 Manslaughter" depending on the word in the Conclusion given.
We would also require further clarity on "natural causes". The official guidance on the completion of the Medical Certificate of cause of death (MCCD) advises to "Never use natural causes alone."
The term "natural causes" alone, with no specification of any disease on a doctor's MCCD, is not sufficient to allow the death to be registered without referral to the coroner. If you do not have any idea what disease caused your patient's death, it is up to the coroner to decide what investigations may be needed." Therefore, there will always be a specific cause of death assigned to the deceased MCCD. All the conditions mentioned on the death certificate are coded using the International Classification of Diseases, Tenth Revision (ICD-10). From all these causes, an underlying cause of death is selected using ICD-10 coding rules. The underlying cause of death is defined by WHO as:
a. the disease or injury that initiated the train of events directly leading to death, or
b. the circumstances of the accident or violence that produced the fatal injury