Jo Revill reports that the mental health 'tsar' believes that mental health services are not sensitised enough to the risks of homicide by psychiatric patients (One person a week killed by mentally ill, December 3). Staff are in fact frightened they will be blamed in a homicide inquiry. Of course it is the role of mental health services to manage the risk of mental illness on behalf of society, but the title of the report Avoidable Deaths should not be taken to mean that society can be protected completely from all such homicides. Nor should a high rate of false negatives necessarily imply that risk assessment needs to be improved. Detecting high risk also needs to be shown to make a difference to outcome. The mental health 'tsar' should support mental health services not attack them and there may be a conflict of interest with his role as director of the National Confidential Inquiry that produced the report.

Duncan Double
Consultant Psychiatrist
Norfolk & Waveney Mental Health Partnership NHS Trust