News Release

Implementation of suicide recommendations across England and Wales led to decreased suicide rates in the decade after implementation began

Peer-Reviewed Publication

The Lancet_DELETED

New research published Online First by The Lancet shows that health authorities in England and Wales that implemented a range of suicide recommendations decreased their suicide rate, while those the did not bring in the recommendations saw little change in their rate. The findings are in an Article by Professor Nav Kapur, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness and Centre for Suicide Prevention, University of Manchester, UK, and colleagues.

Research investigating which aspects of mental health service provision are most effective in prevention of suicide is scarce. In this new research, the authors analysed the effects of key service recommendations made by the National Confidential Inquiry (NCI) into Suicide and Homicide by People with Mental Illness in the 1990s. NCI is a project that aims to monitor suicide and ultimately improve the quality of mental health care in the UK.

As part of the NCI, data were obtained for individuals who died by suicide between 1997 and 2006 who were in contact with mental health services in the 12 months before death. The authors compared suicide rates for services implementing most of the recommendations with those implementing fewer recommendations and examined rates before and after implementation.

The interventions assessed were of widely varying types. They included removal of ligature points from inpatient wards; assertive outreach to provide community support to patients; provision of a 24-hour crisis team; a standard 7-day follow-up for patients discharged from inpatient care; a policy for patients who don't comply with treatment; measures to provide treatment for patients with mental health problems combined with drug and/or alcohol addiction; sharing information with criminal justice agencies; a multidisciplinary review and sharing information with families after a suicide; and training in the management of suicide risk at least every 3 years for all front-line staff.

The authors found that the average number of recommendations implemented increased from 0.3 per service in 1998 to 7.2 in 2006. Implementation of recommendations was associated with lower suicide rates. The provision of 24 h crisis care was associated with the biggest fall in suicide rates: from 11.4 per 10 000 patient contacts per year before to 9.3. Local policies on patients with dual diagnosis (10.6 rate before to 9.6 after); and multidisciplinary review after suicide (11.6 before and 10.5 after) were also associated with falling rates. Services that did not implement recommendations had little reduction in suicide. The biggest falls in suicide seemed to be in services with the most deprived catchment areas (With a rate after intervention at around 10% lower than before). Mental health services with the most patients also appeared to do better, with a rate 14% lower after intervention than before. By 2006, authorities that had implemented between 7 and 9 of the above interventions had a suicide rate of 9.1 per 10000 patient contacts, compared with 11.0 in those that had implemented 0 to 6.

The authors say: "Our findings suggest that aspects of provision of mental health services can affect suicide rates in clinical populations. Investigation of the relation between new initiatives and suicide could help to inform future suicide prevention efforts and improve safety for patients receiving mental health care."

They add: "We believe our findings have implications for mental health services internationally, particularly those in the USA, Europe, and Australasia, which have also had an increased emphasis on community compared with inpatient treatment."

In a linked Comment, Dr Yeates Conwell and Carole Farley-Toombs, University of Rochester Medical Center, Rochester, NY, USA, say: "We cannot take for granted that even the most seemingly obvious intervention designed to reduce suicide is necessarily effective without evidence, or even that the reduction of suicide is a shared public concern warranting allocation of substantial resources for its prevention. This study is important at each of these levels. To have an even greater effect, we need much more evidence."

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For Professor Navneet Kapur, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness and Centre for Suicide Prevention, University of Manchester, UK, please contact Aeron Howarth T) 44-161-275-8383 / 44-7717-881563 E) Aeron.Haworth@manchester.ac.uk

Dr Yeates Conwell, University of Rochester Medical Center, Rochester, NY, USA. T) 585-275-6739 E) yeates_conwell@urmc.rochester.edu


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