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Suicide by mental health in-patients under observation

Published online by Cambridge University Press:  11 April 2017

S. Flynn ,
T. Nyathi ,
S.-G. Tham ,
A. Williams ,
K. Windfuhr ,
N. Kapur ,
L. Appleby  and
J. Shaw
S. Flynn*
Affiliation:
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
T. Nyathi
Affiliation:
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
S.-G. Tham
Affiliation:
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
A. Williams
Affiliation:
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
K. Windfuhr
Affiliation:
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
N. Kapur
Affiliation:
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
L. Appleby
Affiliation:
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
J. Shaw
Affiliation:
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, UK
*
*Address for correspondence: S. Flynn, Ph.D., The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK. (Email: sandra.m.flynn@manchester.ac.uk)
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Abstract

Background

Observations in psychiatric in-patient settings are used to reduce suicide, self-harm, violence and absconding risk. The study aims were to describe the characteristics of in-patients who died by suicide under observation and examine their service-related antecedents.

Method

A national consecutive case series in England and Wales (2006–2012) was examined.

Results

There were 113 suicides by in-patients under observation, an average of 16 per year. Most were under intermittent observation. Five deaths occurred while patients were under constant observation. Patient deaths were linked with the use of less experienced staff or staff unfamiliar with the patient, deviation from procedures and absconding.

Conclusions

We identified key elements of observation that could improve safety, including only using experienced and skilled staff for the intervention and using observation levels determined by clinical need not resources.

Keywords

In-patientSuicideObservationIntermittentConstant
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 13 , October 2017 , pp. 2238 - 2245
Copyright
Copyright © Cambridge University Press 2017 

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