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Investigation of deaths & serious Incidents in mental health services- Towards the Patient Safety Investigation Framework (PSIRF)

Event details

This national conference looks at the practicalities of Serious Incident Investigation and Learning from Deaths in Mental Health Services. The event will look at the development and implementation of the New Patient Safety Incident Response Framework (previously known as the Serious Incident Framework). NHS Improvement is working with these early adopters to test implementation, and analysis of this will inform the final version with the revised framework due in Spring 2022. Local systems and organisations outside of the early adopter areas are free to use the already published version of the PSIRF to start to plan and prepare for PSIRF’s full introduction.

The conference will also update delegates on best current practice in serious incident investigation and learning, including mortality governance and learning from deaths. There will be an extended focus on ensuring serious investigation findings lead to change and improvement, and updates from PSIRF early adopter sites in mental health. The conference will also examine how the new framework will fit with the Royal College of Psychiatrists Care Review Tool for mortality review.

This conference will enable you to:

  • Network with colleagues who are working to improve the investigation of serious incidents and deaths in mental health services.
  • Ensure your approach to Serious Incident Investigation is in line with the Patient Safety Incident Response Framework (PSIRF).
  • Learn from outstanding practice in implementing the Royal College of Psychiatrists Mortality Care Review Tool.
  • Reflect on the lived experience of a bereaved relative.
  • Improve the way you involve and engage families and carers in the investigation process.
  • Develop your skills in incident investigation and mortality review.
  • Understand how you can improve serious incident investigation and learn from Mental Health early adopters of the New Patient Safety Incident Response Framework. 
  • Identify key strategies for undertaking a self assessment, and continuous review of deaths and investigation practice in your organisation.
  • Understand how human factors can help improve learning from serious incident investigation.
  • Ensure you are up to date with the role of the coroner.
  • Understand how you can better support staff when a serious incident occurs. 
  • Self assess and reflect on your own practice.
  • Supports CPD professional development and acts as revalidation evidence. This course provides 5 Hrs training for CPD subject to peer group approval for revalidation purposes.


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