Suicide three times higher among community treated patients, study finds

People with mental health problems who are cared for by community crisis teams are far more likely to kill themselves than those treated in hospital, research shows.

Some 200 suicides occur every year among those receiving crisis resolution and home treatment (CRHT) –  three times the figure for inpatients, according to a study by the University of Manchester's National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH).

Risk assessments

Researchers questioned whether there was too much reliance on home treatment and concluded that crisis teams are unlikely to be a safe setting for patients at high risk or who live alone.

The annual NCISH report found that a third of patients under CRHT who died from suicide had been using the service for less than a week, while a third had been discharged from hospital in the previous 2 weeks. Some 43 per cent lived alone.

The report said: ‘these features suggest that CRHT may not have been a suitable setting for their care’ and there are ‘concerns that CRHT has become the default option for acute mental health care because of pressure on other services’.

Economic pressures 

Economic pressures are also becoming more common antecedents in patient suicides. Unemployment and homelessness have increased and 13 per cent of patients who died by suicide had experienced serious financial difficulties in the previous three months, according to the report.

Professor Louis Appleby, director of NCISH and the government's former national director for mental health, said: ‘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 that 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.’

The research also found that more than half of the 1,700 mental health patients per year who die from suicide have a history of alcohol or drug misuse, but only a small number receive specialist substance misuse treatment.