Call to improve safety of home treatment for mental health patients

The annual report by the University of Manchester's National Confidential Inquiry into Homicide and Suicide by People with Mental Illness (NCI) examined homicide and suicide figures for all four countries of the United Kingdom among mental health patients and found in-patient suicides have shown a sustained fall across all countries. In contrast, the number of suicides by patients receiving home treatment services (also known as crisis-resolution services) has increased. The report shows that in 2009 there were 195 suicides by patients treated at home in England, compared to 84 in-patient suicide deaths. Overall, the number of people under home treatment services has increased over recent years and the number of people admitted to in-patient care has decreased.

The NCI report, which was commissioned by the Healthcare Quality Improvement Partnership on behalf of the Department of Health, England, NHSSPS Northern Ireland, the Scottish Government, the Welsh Government and the Channel Islands, recommends mental health services make home-treatment teams a priority for suicide prevention.

Louis Appleby, Professor of Psychiatry at The University of Manchester and the government's health and criminal justice tsar, said: "Death by suicide among in-patients in mental health wards has fallen dramatically over the past decade but the provision of care has increasingly moved into the community, with over 100,000 patients per year treated by crisis resolution teams. The success in reducing suicide among in-patients now needs to be repeated in patients receiving treatment for acute mental illness at home.

"Suicide prevention measures on wards have been successful and should continue. As a result of removing ligature points and preventing patients going absent without leave, we now have over 100 fewer in-patient suicides per year than a decade ago.

"Doctors are also prescribing more safely, using less toxic drugs, and we are seeing a fall in suicides by overdose of tricyclic antidepressants."

Other main findings of the NCI 2012 annual report include:

• a decrease in the number of patient suicides by overdose of tricyclic antidepressants in England, Wales and Scotland
• a decrease in in-patient suicides following absconding in England
• higher figures for alcohol misuse and dependence in Northern Ireland and Scotland
• rising suicide rates in Northern Ireland, linked to alcohol misuse
• a recent decrease in the number of mental health patients convicted of homicide although it is too early to draw definitive conclusions
• a downward trend in homicides in the general population in Scotland since 2004.

Northern Irish and Scottish rates remain higher than those in England and Wales but suicide rates, both in the general population and among patients, are only rising in Northern Ireland; the majority of individuals there will not have been in contact with mental health services prior to suicide. In Scotland the rate of suicide in the general population has fallen by 14% in the period since 2002.

Provided by University of Manchester