Sir: In their editorial on the high-risk period after discharge from in-patient care, Walker and Eagles (Psychiatric Bulletin, July 2002, 26, 241-242) quote one finding from the Wessex Recent Inpatient Suicide Study (WRISS): key personnel on leave/leaving occurred more often for patients who commit suicide than for controls (5% v. 1%). They state ‘given the average consultant is on leave some 15% of the time, this strongly suggests incomplete or selective recording’.
Closer reading of our paper (Reference King, Baldwin and SinclairKing et al, 2001) may have prevented some erroneous assumptions and enhanced their review about factors during this period.
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1. The WRISS is a retrospective case—control study, using data collected from case notes with manualised operationally-defined criteria and is not, as implied, a psychological autopsy study.
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2. They presume that ‘key personnel’ are always the consultant psychiatrists. We know this is often not the case, distinguish between key personnel (including community psychiatric nurse, keyworker or out-patient doctor) and consultant, and acknowledge this finding is probably artefactual.
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3. More relevant findings, not mentioned by Walker and Eagles, were differences between cases and controls in frequency of unplanned discharge (OR 2.73, 95% CI 1.77-4.22), and the protective factor of supported accommodation.
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4. The WRISS highlights the high-risk period immediately after discharge, concurring with other findings of 34% dying within the first month. The National Confidential Inquiries report that 80% of patients died before their first out-patient appointment and recommend early follow-up, but our case—controlled results show no difference between groups in the percentage of people who were seen between discharge and death, or the equivalent follow-up period.
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