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Mental health services, suicide and 7-day working

  • Nav Kapur (a1) (a2), Saied Ibrahim (a1), Isabelle M. Hunt (a1), Pauline Turnbull (a1), Jenny Shaw (a1) and Louis Appleby (a1)...

Patients admitted to hospital at the weekend appear to be at increased risk of death compared with those admitted at other times. However, a ‘weekend effect’ has rarely been explored in mental health and there may also be other times of year when patients are vulnerable.


To investigate the timing of suicide in high-risk mental health patients.


We compared the incidence of suicide at the weekend v. during the week, and also in August (the month of junior doctor changeover) v. other months in in-patients, patients within 3 months of discharge and patients under the care of crisis resolution home treatment (CRHT) teams (2001–2013).


The incidence of suicide was lower at the weekends for each group (incidence rate ratio (IRR) = 0.88 (95% CI 0.79–0.99) for in-patients, IRR = 0.85 (95% CI 0.78–0.92) for post-discharge patients, IRR = 0.87 (95% CI 0.78–0.97) for CRHT patients). Patients who died by suicide were also less likely to have been admitted at weekends than during the week (IRR = 0.52 (95% CI 0.45–0.60)). The incidence of suicide in August was not significantly different from other months.


We found evidence of a weekend effect for suicide risk among high-risk mental health patients, but with a 12–15% lower incidence at weekends. Our study does not support the claim that safety is compromised at weekends, at least in mental health services.

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Corresponding author
Nav Kapur, Head of Suicide Research, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK. Email:
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The Healthcare Quality Improvement Partnership (HQIP) commissions the Mental Health Clinical Outcome Review Programme, NCISH, on behalf of NHS England, NHS Wales, the Scottish Government Health and Social Care Directorate, the Northern Ireland Department of Health, Social Services and Public Safety (DHSSPS), and the States of Jersey and Guernsey. The views expressed in this paper are those of the authors and not the funding body. The funder had no role in the study design, data collection, data analysis, interpretation of the data or writing of the manuscript. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Declaration of interest

N.K. is partly supported by Manchester Mental Health and Social Care Trust. N.K. chaired the guideline development group for the 2012 NICE guidelines on the longer-term management of self-harm and currently chairs the guideline development group for the NICE depression in adults guideline. L.A. chairs the Suicide Prevention Advisory Group at the Department of Health (of which N.K. is also a member) and is a non-executive Director for the Care Quality Commission.

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Mental health services, suicide and 7-day working

  • Nav Kapur (a1) (a2), Saied Ibrahim (a1), Isabelle M. Hunt (a1), Pauline Turnbull (a1), Jenny Shaw (a1) and Louis Appleby (a1)...
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