The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH) report, published today, suggests the crisis teams are bearing the pressure of caring for patients who actually need a more acute level of care, such as inpatient beds.
The Inquiry reports that there are now around three times as many suicides by crisis resolution and home treatment teams patients as in in-patients, over 200 per year, although after a rise in report last year there has been no further increase in 2014.
The report highlights that:
- A third of CRHT patients who die by suicide have been under the service for less than one week.
- A third have been discharged from hospital in the previous two weeks.
- 43% live alone.
These features lead the researchers to question whether CRHTT may not have been a suitable setting for their care and raise concerns that CRHT has become the default option for acute mental health care because of pressure on other services, particularly beds.
The report states that crisis teams are unlikely to be a safe setting for patients at high risk or who live alone and that the use of crisis teams or CRHT should be kept under regular review
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness is published annually. This year’s report presents findings from 2004 to 2014, and reviews 20 years of data collection. It provides the latest figures on suicide, homicide and sudden unexplained deaths and highlights the priorities for safer services
Trends in suicide: Lessons from 20 Years of the National Confidential Inquiry
Data shows that the number of patient suicides in the UK, driven by figures from England, has risen over 20 years. However, the patient suicide rate, i.e. taking into account increases in the number of people under mental health care, has fallen. The decrease has been around 60% during 2004-14.
The calculation however is not straightforward, and is complicated by inconsistent estimates of total patient numbers and a changing clinical population.
Changing patterns of suicide
The pattern of suicide since 2004 is (1) a continued fall from previous years, reaching a historical low in 2006 and 2007, (2) a rise in 2008 and 2012, with intervening years being lower, influenced by under-recording of “narrative” verdicts, (3) falling rates in 2013 and 2014.
Age and gender
Since 2004, there has been a fall in male suicide rates in those aged 25-34; increases in those aged 45-54 and 55-64; and no overall changes in other age groups. In females, rates fell in those aged 25-34 and rose in 55-64 year olds.
Suicide rates in men aged 45-54 have risen by 27% since 2006. Rates have risen by 20% in men aged 55-64.
Suicide rates varied by the 44 health and care systems recently announced for England (Sustainability and Transformation Plan (STP) ‘footprints’). In general the highest rates were in the north and south-west, with the lowest rates in London and the south-central areas.
Drug and alcohol
The number of suicides in patients with a history of alcohol or drug misuse has increased (Figure 16). Between 2012-2014, 240 (7%) patients were under drug services, 247 (7%) were under alcohol services, and 392 (11%) were under either drug or alcohol services.
Certain risk factors have become more common as antecedents of suicide - these are the factors that services have to address to reduce risk. They include:
- economic adversity
- alcohol and drug misuse
- recent self-harm
Non-adherence to medication in the period leading to suicide has become less common; loss of contact is less frequent than 20 years ago but continues to be a common antecedent.
The report recommends that mental health services should be aware of the changing nature of patients at risk of suicide, i.e. economic problems, recent immigration, isolation and be able to work with services with specialist expertise in these areas.
Reducing suicide risk
There are a number of ways in which mental health care is safer for patients, and the report highlights:
- Safer wards
- Early follow-up on discharge
- No out-of-area admissions
- 24 hour crisis teams
- Outreach teams
- Dual diagnosis service
- Family involvement in ‘learning lessons’
- Guidance on depression
- Personalised risk management
- Low staff turnover
For a copy of the report click here.
For a copy of the infographics sheet for key messages click here.