Suicide within 12 months of contact with mental health services: national clinical survey

Objective To describe the clinical circumstances in which psychiatric patie nts commit suicide. Design National clinical survey: Setting England and Wales. Subjects A two year sample of people who had committed suicide, in particul ar those who had.been in contact with mental health services in the 12 mont hs before death. Main outcome measures Proportion of suicides in people who had had recent c ontact with mental health services; proportion of suicides in inpatients; p roportion of people committing suicide and timing of suicide within three m onths of hospital discharge; proportion receiving high priority under the c are programme approach; proportion who were recently non-compliant and not attending. Results 10 040 suicides were notified to the study between April 1996 and M arch 1998, of whom 2370 (24%; 95% confidence interval 23% to 24%) had had c ontact with mental health services in the year before death. Data were obta ined on 2177, a response rate of 92%. In general these subjects had broad s ocial and clinical needs. Alcohol and drug misuse were common. 358 (16%; 15 % to 18%) were psychiatric inpatients at the time of death, 21% (17% to 25% ) of whom were under special observation. Difficulties in observing patient s because of ward design and nursing shortages were both reported in around a quarter of inpatient suicides. 519 (24%; 22% to 26%) suicides occurred w ithin three months of hospital discharge, the highest number occurring in t he first week after discharge. 914 (43%; 40% to 44%) were in the highest pr iority category for community care. 488 (26% excluding people whose complia nce was unknown; 24% to 28%) were non-compliant with drug treatment while 4 86 (28%; 26% to 30%) community patients had lost contact with services. Mos t people who committed suicide were thought to have been at no or low immed iate risk at the final service contact Mental health teams believed suicide could have been prevented in 423 (22%; 20% to 24%) cases. Conclusions Several suicide prevention measures in mental health services a re implied by these findings, including measures to improve compliance and prevent loss of contact with services. Inpatient facilities should remove s tructural difficulties in observing patients and fixtures that can be used in hanging. Prevention of suicide after discharge may require earlier follo w up in the community. Better suicide prevention in psychiatric patients is likely to need measures to improve the safety of mental health services as a whole, rather than specific measures for people known to be at high risk .