Article2012

Psychiatric in-patient care and suicide in England, 1997 to 2008: a longitudinal study

Navneet Kapur · Isabelle M. Hunt · Kirsten L. Windfuhr · Cathryn Rodway · Roger Thomas Webb · Mohammad Shaiyan Rahman +2 more

60 citations0/0 files storedPsychological Medicine

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Suicide and Self-Harm Studies Psychiatric care and mental health services Homicide, Infanticide, and Child Abuse

Abstract

BACKGROUND: Psychiatric in-patients are at high risk of suicide. Recent reductions in bed numbers in many countries may have affected this risk but few studies have specifically investigated temporal trends. We aimed to explore trends in psychiatric in-patient suicide over time. METHOD: A prospective study of all patients admitted to National Health Service (NHS) in-patient psychiatric care in England (1997-2008). Suicide rates were determined using National Confidential Inquiry and Hospital Episode Statistics (HES) data. RESULTS: Over the study period there were 1942 psychiatric in-patient suicides. Between the first 2 years of the study (1997, 1998) and the last 2 years (2007, 2008) the rate of in-patient suicide fell by nearly one-third from 2.45 to 1.68 per 100,000 bed days. This fall in rate was observed for males and females, across ethnicities and diagnoses. It was most marked for patients aged 15-44 years. Rates also fell for the most common suicide methods, particularly suicide by hanging on the ward (a 59% reduction). Although the number of post-discharge suicides fell, the rate of post-discharge suicide may have increased by 19%. The number of suicide deaths in those under the care of crisis resolution/home treatment teams has increased in recent years to approximately 160 annually. CONCLUSIONS: The rate of suicide among psychiatric in-patients in England has fallen considerably. Possible explanations include falling general population rates, changes in the at-risk population or improved in-patient safety. However, a transfer of risk to the period after discharge or other clinical settings such as crisis resolution teams cannot be ruled out.

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References

1997Suicide as an outcome for mental disorders 2005Suicide Risk in Relation to Psychiatric Hospitalization 2004Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries 2003The National Suicide Prevention Strategy for England 2012Implementation of mental health service recommendations in England and Wales and suicide rates, 1997–2006: a cross-sectional and before-and-after observational study 1999Safer Services: Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness 2006Crisis resolution/home treatment teams and psychiatric admission rates in England 2006Avoidable Deaths: Five year report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness

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2017Risk Estimates and Risk Factors Related to Psychiatric Inpatient Suicide—An Overview 2020High suicide rates during psychiatric inpatient stay and shortly after discharge 2016Suicide risk in primary care patients diagnosed with a personality disorder: a nested case control study

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