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

Published online by Cambridge University Press:  17 May 2012

N. Kapur ,
I. M. Hunt ,
K. Windfuhr ,
C. Rodway ,
R. Webb ,
M. S. Rahman ,
J. Shaw  and
L. Appleby
N. Kapur*
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Risk, University of Manchester, UK
I. M. Hunt
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Risk, University of Manchester, UK
K. Windfuhr
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Risk, University of Manchester, UK
C. Rodway
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Risk, University of Manchester, UK
R. Webb
Affiliation:
Centre for Women's Mental Health Research, Centre for Mental Health and Risk, University of Manchester, UK
M. S. Rahman
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Risk, University of Manchester, UK
J. Shaw
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Risk, University of Manchester, UK
L. Appleby
Affiliation:
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Risk, University of Manchester, UK
*
*Address for correspondence: Professor N. Kapur, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Risk, Jean McFarlane Building, University of Manchester, Manchester M13 9PL, UK. (Email: nav.kapur@manchester.ac.uk)
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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.

Keywords

Psychiatric in-patientsratessuicidetrends
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 1 , January 2013 , pp. 61 - 71
Copyright
Copyright © Cambridge University Press 2012

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References

Appleby, L, Kapur, N, Shaw, J, Hunt, IM, Flynn, S, While, D, Turnbull, P, Windfuhr, K, Williams, A, Rodway, C, Roscoe, A, Rahman, MS (2011). National Confidential Inquiry Annual Report: England, Wales, and Scotland July 2011 (www.medicine.manchester.ac.uk/mentalhealth/research/suicide/prevention/nci/inquiryannualreports/Annual_Report_July_2011.pdf).Google Scholar
Appleby, L, Shaw, J, Amos, T, McDonnell, R, Kiernan, K, Davies, S, Harris, C, McCann, K, Bickley, H, Parsons, R (1999). Safer Services. Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. The Stationery Office: London.Google Scholar
Appleby, L, Shaw, J, Kapur, N, Windfuhr, K, Ashton, A, Swinson, N, While, D, Lowe, R, Bickley, H, Flynn, S, Hunt, IM, McDonnell, S, Rodway, C, Roscoe, A, Turnbull, P, Burns, J, Hadfield, K, Stones, P (2006). Avoidable Deaths. Five Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Department of Health: London.Google Scholar
Appleby, L, Shaw, J, Sherratt, J, Amos, T, Robinson, J, McDonnell, R, McKann, K, Parsons, R, Hunt, IM, Burns, J, Bickley, H, Kiernan, K, Davies, S, Harris, C (2001). Safety First. Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Department of Health: London.Google Scholar
Bartholomew, D, Duffy, D, Figgins, N (2009). Strategies to Reduce Missing Patients. National Mental Health Development Unit: London.Google Scholar
Bhui, KS, McKenzie, K (2008). Rates and risk factors by ethnic group for suicides within a year of contact with mental health services in England and Wales. Psychiatric Services 59, 414–420.CrossRefGoogle ScholarPubMed
Bowers, L, Banda, T, Nijman, H (2010). Suicide inside: a systematic review of inpatient suicides. Journal of Nervous and Mental Disease 198, 315–328.CrossRefGoogle ScholarPubMed
CASP (2004). The CASP Blueprint for a Canadian National Suicide Prevention Strategy. Canadian Association for Suicide Prevention (www.suicideprevention.ca).Google Scholar
Cassells, C, Paterson, B, Dowding, D, Morrison, R (2005). Long and short term risk factors in the prediction of in-patient suicide: a review of the literature. Crisis 26, 53–63.CrossRefGoogle Scholar
Currier, GW (2000). Psychiatric bed reductions and mortality among persons with mental disorder. Psychiatric Services 51, 851.CrossRefGoogle Scholar
Department of Health (2000). An Organisation with a Memory. Report of an expert group on learning from adverse events in the NHS chaired by the Chief Medical Officer. The Stationery Office: London.Google Scholar
Department of Health (2001). The Mental Health Policy Implementation Guide. The Stationery Office: London.Google Scholar
Department of Health (2002 a). National Suicide Prevention Strategy for England. Department of Health: London.Google Scholar
Department of Health (2002 b). Mental Health Policy Implementation Guide: Adult Acute In-patient Provision. Department of Health: London.Google Scholar
Department of Health (2009). Performance Data and Statistics(www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/Beds/DH_083781). Accessed 24 November 2010.Google Scholar
Gardner, W, Mulvey, EP, Shaw, EC (1995). Regression analyses of counts and rates: Poisson, overdispersed Poisson, and negative binomial models. Psychological Bulletin 118, 392–404.CrossRefGoogle ScholarPubMed
Glover, G, Arts, G, Suresh Babu, K (2006). Crisis resolution/home treatment teams and psychiatric admission rates in England. British Journal of Psychiatry 189, 441–445.CrossRefGoogle ScholarPubMed
Gunnell, D, Hawton, K, Kapur, N (2011). Coroners' verdicts and suicide statistics in England and Wales. British Medical Journal 343, d6030.CrossRefGoogle ScholarPubMed
Hampton, T (2010). Depression care effort brings dramatic drop in large HMO population's suicide rate. Journal of the American Medical Association 303, 1903–1904.CrossRefGoogle ScholarPubMed
Harris, EC, Barraclough, B (1997). Suicide as an outcome for mental disorder. A meta-analysis. British Journal of Psychiatry 170, 205–228.CrossRefGoogle ScholarPubMed
Harrison, J, Rajashankar, S, Davidson, S (2011). From home treatment to crisis: the impact of national targets. The Psychiatrist 35, 89–91.CrossRefGoogle Scholar
Hill, C, Cook, L (2011). Narrative verdicts and their impact on mortality statistics in England and Wales. Health Statistics Quarterly 49, 81–100.CrossRefGoogle Scholar
Hoang, U, Stewart, R, Goldacre, JM (2011). Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999–2006. British Medical Journal 343, d5422.CrossRefGoogle ScholarPubMed
Joint Commission Resources (2007). Suicide Prevention: Toolkit for Implementing National Patient Safety Goal 15A. Joint Commission Resources: Oakbrook Terrace, IL.Google Scholar
Kapur, N, Hunt, IM, Webb, R, Bickley, H, Windfuhr, K, Shaw, J, Appleby, L (2006). Suicide in psychiatric in-patients in England, 1997 to 2003. Psychological Medicine 36, 1485–1492.CrossRefGoogle ScholarPubMed
Keown, P, Mercer, G, Scott, J (2008). Retrospective analysis of hospital episode statistics, involuntary admissions under the Mental Health Act 1983, and number of psychiatric beds in England 1996–2006. British Medical Journal 337, a1837.CrossRefGoogle ScholarPubMed
Keown, P, Weich, S, Bhui, KS, Scott, J (2011). Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988-2008: ecological study. British Medical Journal 343, d3736.CrossRefGoogle ScholarPubMed
Lieberman, DZ, Resnnik, HLP, Holder-Perkins, V (2004). Environmental risk factors in hospital suicide. Suicide and Life-Threatening Behavior 34, 448–453.CrossRefGoogle ScholarPubMed
Madsen, T, Agerbo, E, Mortensen, PB, Nordentoft, M (2012). Predictors of psychiatric inpatient suicide: a national prospective register-based study. Journal of Clinical Psychiatry 73, 144–151.CrossRefGoogle ScholarPubMed
MHMDS (2009). Mental Health Minimum Dataset (www.ic.nhs.uk/services/mental-health/mental-health-minimum-dataset-mhmds). Accessed 24 November 2010.Google Scholar
National Audit Office (2007). Helping People through Mental Health Crisis: The Role of Crisis Resolution and Home Treatment Services. The Stationery Office: London.Google Scholar
NIMHE (2008). National Suicide Prevention Strategy for England: Annual Report 2007. National Institute for Mental Health in England. Department of Health: London.Google Scholar
NPSA (2009). Preventing Suicide. A Toolkit for Mental Health Services. National Patient Safety Agency: London.Google Scholar
Pirkola, S, Sohlman, B, Heila, H, Wahlbeck, K (2007). Reductions in postdischarge suicide after deinstitutionalization and decentralization: a nationwide register study in Finland. Psychiatric Services 58, 221–226.CrossRefGoogle ScholarPubMed
Priebe, S, Badesconyi, A, Fioritti, A, Hansson, L, Kilian, R, Torres-Gonzales, F, Turner, T, Wiersma, D (2005). Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries. British Medical Journal 330, 123–126.CrossRefGoogle ScholarPubMed
Qin, P, Nordentoft, M (2005). Suicide risk in relation to psychiatric hospitalization. Evidence based on longitudinal registers. Archives of General Psychiatry 62, 427–432.CrossRefGoogle ScholarPubMed
Rantanen, H, Koivisto, AM, Salokangas, RK, Helminen, M, Oja, H, Pirkola, S, Wahlbeck, K, Joukamaa, M (2009). Five-year mortality of Finnish schizophrenia patients in the era of deinstitutionalization. Social Psychiatry and Psychiatric Epidemiology 44, 135–142.CrossRefGoogle ScholarPubMed
While, D, Bickley, H, Roscoe, A, Windfuhr, K, Rahman, S, Shaw, J, Appleby, L, Kapur, N (2012). Implementation of mental health service recommendations in England and Wales and suicide rates, 1997–2006: a cross-sectional and before-and-after observational study. Lancet 379, 1005–1012.CrossRefGoogle ScholarPubMed
Yoon, J, Bruckner, TA (2009). Does deinstitutionalization increase suicide? Health Services Research 44, 1385–1405.CrossRefGoogle ScholarPubMed