Analysis

Almost 30% of suicides are by mental health patients, report finds

An anniversary report, published by the University of Manchester, details the suicide rates by patients under mental health care.
Suicide rates

The University of Manchester has published a report covering two decades of evidence from its National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH) report.

This year is the 20th anniversary of the report, which considers research on suicide and homicide by people with mental illness. The report reveals that 28% of suicides in the UK between 2004 and 2014 (18,172 deaths) were by people receiving mental health care.

60%

decrease in suicides by mental health inpatients in England

Although the report demonstrates progress in mental health care and improvements in some areas of suicide prevention, it reveals the concerning figure that more than 200 suicide deaths per year now happen among patients in the community under the care of mental health crisis teams.

One third of patients under crisis resolution/home treatment (CRHT) who

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The University of Manchester has published a report covering two decades of evidence from its National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH) report.


Picture: Alamy

This year is the 20th anniversary of the report, which considers research on suicide and homicide by people with mental illness. The report reveals that 28% of suicides in the UK between 2004 and 2014 (18,172 deaths) were by people receiving mental health care.

60%

decrease in suicides by mental health inpatients in England 

Although the report demonstrates progress in mental health care and improvements in some areas of suicide prevention, it reveals the concerning figure that more than 200 suicide deaths per year now happen among patients in the community under the care of mental health crisis teams.

One third of patients under crisis resolution/home treatment (CRHT) who died by suicide had been using the service for less than a week and one third had been discharged from hospital in the previous 2 weeks, according to the report.

The researchers from the University of Manchester state that although the introduction of 24-hour CRHT appears to add to the safety of the service overall, they found evidence it has become the default option in acute care, used for too many patients at high risk.

A total of 44% of patients who die by suicide under CRHT live alone and the report warns that home treatment may not be suitable for people who lack other social support.

18,172

suicides by people under mental health care in the UK between 2004 and 2014

RCN mental health lead Ian Hulatt says CRHT needs to be provided in a more targeted manner, rather than used by default because of a lack of beds.

‘We know the real progress that has been made in relatively controlled environments, but the level of supervision and management of risk is far more challenging in community settings. That is why the offer of CRHT needs to be made by an appropriately resourced and skilled team.’

Increasing reliance on team care

NCISH director Louis Appleby, warns: ‘This year’s report reflects the increasing reliance on crisis teams in response to the strains felt by acute mental health services. Our findings suggest we are accepting too much risk in the home treatment these teams offer, and the crisis team is now the priority for suicide prevention in mental health.’

3 times

as many deaths among patients under the care of mental health crisis teams as in-patients

The government’s Mental Health Taskforce’s Five Year Forward View for mental health included an objective to reduce suicide levels by 10%.

Health secretary Jeremy Hunt singled out mental health and suicide in his speech to the Conservative party conference at the start of October, pointing out that of the 13 suicides every day, nearly three quarters had no contact with NHS mental health services in the previous year.

He said that the government legislated for parity of esteem between physical and mental health adding that it was ‘time to deliver it with an improved suicide prevention strategy in a safer NHS that gives mental health the same priority as physical health’.

The NCISH report shows there has been a change in risk factors for poor mental health over the past two decades, highlighting higher rates of isolation, recent self-harm, alcohol and drug misuse and economic adversity in those who took their lives.

More than half of the 1,700 mental health patients who die each year by suicide across the UK had a history of alcohol or drug misuse, but only a small proportion received specialist substance misuse treatment.

44%

of the patients under care of crisis resolution/home treatment teams who die by suicide live alone ,

More patients who died by suicide were reported as having been unemployed or homeless, and 13% had experienced serious financial difficulties in the previous 3 months.

There has also been a rising incidence of suicides by patients who had been in the UK for less than 5 years, the report reveals.

There were 348 patient suicides in 2011-2014 by people who were resident in the UK for less than 5 years. This represents 5% of all patient suicides, an average of 87 per year, including 20 over the 4 year period who had been seeking permission to stay in the UK.         

There has been a fall in patient homicides overall, but a possible increase by patients with schizophrenia in England since 2009.

Mind chief executive Paul Farmer says although the report indicates the progress made, there is a long way to go to achieving the goal of zero suicides.

‘Every year, hundreds of people under the care of mental health crisis teams are ending their lives. It’s a tragedy that anyone who is already in touch with services, and has asked for help, should reach this point.

‘NHS mental health services need to be able respond when people reach out, from early treatment to help prevent people becoming more unwell, to an emergency response that can provide urgent, appropriate, local care when someone is at their most vulnerable’. 

Case study

Cambridgeshire and Peterborough NHS Foundation Trust launched a pilot scheme in September to allow people in the region to access a new mental health team when they dial NHS helpline number 111.

The extension of the 111 service will mean callers who are experiencing a mental health crisis will be able to dial the number, and by choosing ‘option 2’ will be put through to a member of the trust’s new first response service.

Specially-trained mental health staff will speak to callers and discuss with them their mental healthcare needs – instead of them having to go to emergency departments of local acute hospitals.

Mental health charity Mind in Cambridgeshire, working closely with the trust, has opened two ‘safe-haven sanctuaries’ in Peterborough and Cambridge for those experiencing a mental health crisis. They offer people somewhere to go where they can access emotional and practical support, rather than having to attend hospital.

The projects are part of the urgent and emergency care vanguard programme in Cambridgeshire and Peterborough, which is intended to improve the way urgent mental health care is delivered and reduce the pressure on acute hospitals.

Elaine Young, the trust’s vanguard programme lead, says: ‘If people have physically harmed themselves then A&E is the right place to go. But more often people just want someone to talk to, and advice on what help is available and which services they can access.’

Recommendations

The authors of the NCISH report suggest priorities for mental health services in improving safety that should be taken up by mental health providers, commissioners, clinical staff, training organisations, regulators and health service leaders. These include:

  • The use of crisis teams or CRHT should be kept under regular review.
  • Services should ensure that patients are followed up within 2-3 days of hospital discharge and that care plans are in place.
  • Specialist alcohol and drug services should be available.
  • Mental health services should be aware of the changing nature of patients at risk of suicide, including economic problems, recent immigration and isolation, and be able to work with services with specialist expertise in these areas.
  • Liaison psychiatry teams offering 24-hour specialist psychosocial assessment and follow-up should be available, with specific arrangements for people under mental health care.

 


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