The study, funded by the National Patient Safety Agency, which covers the period 1997-2006, is based on data collected by NCI at the University of Manchester on individuals aged 10 and older who had died from suicide, and who had been in contact with mental health services over the previous 12 months. Suicide was defined as ‘deaths that received a suicide or open verdict at the coroners inquest’.
As has been established by previous studies, service related risk factors for suicide include poor continuity of care, scarcity of well developed mental health services in the community, short length of inpatient stay and missed appointments within services.
The study focuses on nine key service recommendations selected from a priori from the 12 points to a safer service summary for specialist services first published in 2001 and included in the English Suicide Prevention Strategy.
The study had four specific objectives:
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To examine the implementation of key service recommendations by providers of mental health services in England and Wales with time
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To examine the cross-sectional association between the number of recommendations implemented and suicide rate across providers
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To measure suicide rates before and after implementation within providers
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To investigate the effect of individual recommendations on suicide risk in specific clinical subgroups.
The results
From 1997 – 2006 the NCI recorded 12,881 suicides within England and Wales within 91 mental health services, accounting for 26% of 50,437 suicides in England and Wales during this period. Prior to 1998 most services had not introduced any key recommendations. However, during the study period this gradually increased, from 0.3 per service in 1998 culminating in 7.2 key recommendations implemented in 2006.
From 2004 onwards, services that had implemented at least 7 of the key recommendations had a significantly lower suicide rate than those implementing fewer than 7. Three of the recommendations were associated with a statistically significant reduction:
What the study also found was different recommendations were more relevant to specific clinical groups. For example, the removal of ligature points was associated with significant reductions in the overall psychiatric inpatient suicide rate. Similarly, implementation of an assertive outreach policy was associated with a significant decrease in the suicide rate of those who were non compliant with medication or missed their last appointment.
The study also shows that the biggest falls in suicide were recorded in the services with the most deprived catchment area and the largest clinical population.
Conclusion
The authors believe their findings have implications for mental health services internationally, particularly in countries which place an increased emphasis on community, compared with inpatient, treatment.
The article stresses the importance of data collection in order to support further service improvement. Obtaining data on the timing of new interventions, the extent and quality of implementation, and their effect on other important outcomes such as self harm or readmission will help to show which innovations might be most helpful in prevention of suicide but should help to inform safer service provision for all patients under the care of mental health services.
Read more
To read the study in full, please visit the University of Manchester website.