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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

Information

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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