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  • Writer's pictureTom Robinson

Mental health unit suicide ‘didn’t need to happen’: why are patients dying on our psychiatric wards?

Updated: Jan 29, 2022

There was another article on the BBC News page a couple of weeks ago, which once again, highlighted the terrible shortcomings of the current psychiatric system in this country.

I’m getting all sorts of messages from people who have lost loved ones to mental health issues, and in almost every case there’s a mention of the failures and oversights that happened in their care.

The message in the media is ‘seek help’ and ‘talk’ but so many people are still losing their lives because the support and care available when you do reach out is lacking and quite frankly, substandard.

One would think that if a patient is sectioned or detained in a psychiatric hospital that his or her life would be safe, but sadly this isn’t the case at all, with suicide within our psychiatric wards happening far more often than people even realise.

Azra Hussain, 41, died in May last year at a mental health unit run by an NHS trust in Birmingham and her death leaves many questions to be answered.

Ms Hussain had spoken to her daughters about her intentions to take her own life during her admission and they contacted staff at the unit to warn them.

This message went unrecorded, and the risk of suicide was not re-evaluated which, along with other failings, led to Ms Hussain’s death by hanging from the bathroom door.

This tragedy made me think about a terrible failing that happened in my own care in one of my hospital admissions where an important message went uncommunicated and could easily have resulted my death.

In 2014, I was discharged to an empty house from an NHS psychiatric ward even though the psychiatric team knew that my parents were out of the country.

I didn’t know the full story until more recently when Dad told me that he had expressly stated that in the unlikely event of my release, he would pay for me to go to a place of safety, to be looked after and supported until they returned.

This message was not ‘communicated’ and the result was that I had another frightening episode when I was on my own and my friends had to dash over and take me back to the hospital.

Incidents like this happen all the time, which is unforgivable and although the system is failing because of a lack of funds it does sometimes come down to individual staff failings.

Although there are a handful of really excellent staff there are many that are seriously lacking in compassion, empathy and education.

This is not just my own opinion because all of the people that I know who have been through these wards as inpatients say the same thing.

Being sectioned or admitted to a psychiatric ward does not happen unless the patient is severely unwell and/or suicidal yet the seriousness of the situation is so often unappreciated which results in tragedy time and again.

There are four levels of observations in NHS psychiatric hospitals with specific instructions and guidelines for staff, but having read it, I can tell you that these vital directives never get followed properly.

Azra Hussain was on level 2 observations when she died, which involves only being checked every 15-30 minutes. This was clearly wrong when she had already distinctly informed her daughters of her suicidal thoughts and intentions.

The higher levels of 3 and 4 observations involve constant one to one attention 24 hours a day to ensure the patient cannot harm or kill themselves at any time.

But even when you are under this critical level of care the failures and tragedies continue to happen, because I have got up in the night, left my bed, and walked past my level 4 staff member who was fast asleep on a chair outside my door!

I have often walked around the ward, watched TV, and gone to the loo and back without anyone noticing, which is frightening because if I’d had suicidal intentions, I could easily have taken my own life.

Friends tell me similar stories, and this is why we’re losing people on our psychiatric wards – because of the constant failures and oversights.

There were so many other incidents in my last admission where things were overlooked or neglected, an example of which is when a mental health nurse tried to give me the wrong antipsychotic medication at completely the wrong dose!

Fortunately, I was switched on enough to notice these appalling and unforgivable mistakes and when I realised that the system was not going to help me, I resorted to blocking out the pandemonium by putting my earphones in and talking to no one!

But how is any of this ok? It’s a sad and worrying state of affairs and losing people to suicide when they are inpatients is not only devastating but totally inexcusable. These deaths and failings must be fully investigated, not just for the sake of the families affected but for the care of vulnerable patients in the future.

Azra Hussain's daughters are now calling for a public inquiry so that other families don’t have to go through a similar experience. In a heartbreaking statement they said:

“As a family we don’t want to hear that this has happened again, we want people to go into a place of care… and not have to worry about them never coming out again.”

I hope that this inquiry goes ahead because these devastated families deserve to know the truth, which is the very least that can be done for them.

Unfortunately, I know that this doesn’t always happen, because I was contacted recently by a mother who lost her son while he was an inpatient on a psychiatric ward, and she is still campaigning for a public inquiry 9 years after his death.

I am having to take a deep breath again this morning because every one of these cases is so upsetting and perturbing quite frankly, and I know that at this very moment there are thousands of vulnerable patients at risk on wards around the country.

It terrifies me when I think about the state of psychiatric care in less developed countries because if it’s like this in the U.K then what the hell is it like in eastern Europe or Africa?

I know that my comments will upset some of the people that work in mental health, so to demonstrate my good intentions I will firstly be documenting all of this and highlighting some of the issues and then fundraising and campaigning in an attempt to help!

If you would like to read the article on the BBC News page then you can find it here.

Thanks for reading,

Speak to you soon,


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Mari Jmk
Mari Jmk
Apr 16, 2021

Thank you for sharing my mom's story and helping to raise awareness. I am so sorry to hear that you were let down too, you didn't deserve such dereliction of duty- no one does. You'd think that those under the care of psychiatric wards are safe but in reality that's not the case. If you search 'Hazel Joy', sadly she was also failed by the same ward that my mom was on, just 3 months later. It's appalling and considering every single person struggles with Mental Health at some point or another, the Mental Health Sector is severely lacking. I have much more to share and I hope that you will follow what's yet to come. I am working on…

Feb 03, 2022
Replying to

Hi Mari,

I'm so so sorry for your loss. I will most definitely check out your page. I am so sorry I missed this comment at the time. I will be in touch. Thank you for your support and yes we must stick together. X Tom

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