Mental health and addiction services in the South had 21
serious adverse events last year, a new report shows.
The Health Quality and Safety Commission report is the first
to compile the incidence of serious adverse events in mental
health and addiction services, in both inpatient and
Of the 177 serious adverse events nationally in 2012-13, 134
The other events were: serious self-harm (17), serious
adverse behaviour (17), going missing from a facility
(causing no harm, 5), other event resulting in patient harm
Most of the events, 87%, involved patients in the community,
where 90% of care is provided.
Its 21 incidents put the Southern District Health Board third
of the 20 health boards. However, incidents are not shown by
type for each board.
Commission chief executive Dr Janice Wilson said the report
was a first step in tackling the problem of harm to mental
health and addiction service patients.
The commission and the Ministry of Health had agreed
previously to conduct a two-year mortality review trial
related to patterns of suicidal behaviour, and to find ways
to identify intervention points for suicide prevention.
A report of the expert group's findings and recommendations
would be published at the end of the trial.
It was not possible to compare suicide numbers with suicides
reported in previous years, because they now counted patients
who had had contact with mental health services within 28
days, rather than the previous measure of seven days.