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Cited by 96Suicide and Self-Harm StudiesPsychiatric care and mental health servicesHealthcare Quality and Management

Mental health service changes, organisational factors, and patient suicide in England in 1997–2012: a before-and-after study

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Kapur, Nav, Ibrahim, Saied, While, David, Baird, Alison, Rodway, Cathryn, Hunt, Isabelle M, Windfuhr, Kirsten, Moreton, Adam +2 more·2016·The Lancet Psychiatry
DOI 10.1016/s2215-0366(16)00063-8
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Abstract

Background Research into which aspects of service provision in mental health are most effective in preventing suicide is sparse. We examined the association between service changes, organisational factors, and suicide rates in a national sample.Methods We did a before-and-after analysis of service delivery data and an ecological analysis of organisational characteristics, in relation to suicide rates, in providers of mental health care in England. We also investigated whether the effect of service changes varied according to markers of organisational functioning.Findings Overall, 19 248 individuals who died by suicide within 12 months of contact with mental health services were included (1997-2012). Various service changes related to ward safety, improved community services, staff training, and implementation of policy and guidance were associated with a lower suicide rate after the introduction of these changes (incidence rate ratios ranged from 0·71 to 0·79, p<0·0001). Some wider organisational factors, such as non-medical staff turnover (Spearman's r=0·34, p=0·01) and incident reporting (0·46, 0·0004), were also related to suicide rates but others, such as staff sickness (-0·12, 0·37) and patient satisfaction (-0·06, 0·64), were not. Service changes had more effect in organisations that had low rates of staff turnover but high rates of overall event reporting.Interpretation Aspects of mental health service provision might have an effect on suicide rates in clinical populations but the wider organisational context in which service changes are made are likely to be important too. System-wide change implemented across the patient care pathway could be a key strategy for improving patient safety in mental health care.Funding The Healthcare Quality Improvement Partnership commissions the Mental Health Clinical Outcome Review Programme, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, on behalf of NHS England, NHS Wales, the Scottish Government Health and Social Care Directorate, the Northern Ireland Department of Health, Social Services and Public Safety, and the States of Jersey and Guernsey.

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  • A U.K. study found reduced suicide rates with incident rate ratios of .71-.79 for an array of clinical service changes including improved depression management, continuity of care, improved community services, and lower staff turnover.

    “One study in the United Kingdom (34) found benefit for an array of clinical service changes including improved depression management, continuity of care from adolescent patient services to adult patient services, improved community services and lower staff turnover and found reduced suicide rates with incident rate ratios of .71–.79.”

    From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [34]

    The Summary (p. 1) reports incidence rate ratios of 0.71–0.79 for service changes, and the Results (p. 5) identify depression guidance, community treatment teams, and transitions to adult services among changes associated with lower suicide rates. The paper treats low staff turnover separately as an organisational factor that strengthened the association between service changes and reduced suicide rates (Results, p. 6), not as a clinical service change with an incidence rate ratio in that range. (LLM, conf=0.88)

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  • Even in countries with accessible, free-at-the-point-of-use mental health services such as the UK, only ~25% of people dying by suicide are in current or recent contact with mental health services.

    “even in countries with accessible, free -at-the-point-of-use, mental health services such as the UK, only ~25% of people dying by suicide are in current or recent contact with mental health services 94 .”

    From Suicide and suicide risk (2019) · cites this paper as [94]

    The Results (p. 5) report that 26% of suicide deaths in England in 1997–2012 involved people who had been in contact with mental health services within the preceding 12 months, supporting the approximate 25% figure. The Suicide data section (p. 2) says the study was restricted to England, not the whole UK; our copy also does not establish that the services were accessible and free at the point of use. (LLM, conf=0.86)

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  • The U.K. study observed the decline in a sample of 19,248 suicides who were in treatment within 12 months of death studied 1997-2012.

    “The decline in suicide rates was observed in the study sample of 19,248 suicides who were in treatment within 12 months of death studied 1997–2012.”

    From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [34]

  • These and other elements of re-engineering practice have been shown in the UK to yield suicide reductions of 22-29%.

    “These and other elements of re‐engineering practice have been shown in the UK to yield suicide reductions of 22‐29% 233 .”

    From Mental health care for older adults: recent advances and new directions in clinical practice and research (2022) · cites this paper as [233]

  • Within public primary-care facilities in Goa, the engagement of lay health workers in the care of people with common mental disorders was not only cost-effective but also cost-saving.

    “Within public primary-care facilities in Goa, the engagement of lay health workers in the care of people with common mental disorders was not only cost-effective but also cost-saving. 617”

    From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [617]

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Authors
Kapur, N., Ibrahim, S., While, D., Baird, A., Rodway, C., Hunt, I. M., Windfuhr, K., Moreton, A., Shaw, J., & Appleby, L.
Affiliations
Manchester Academic Health Science Centre (GB)
ORCID
Venue
The Lancet Psychiatry
Publisher
Elsevier BV
Published
2016-06
Volume
3
Issue
6
Pages
526-534
ISSN
2215-0366 (ISSN-L)
DOI
10.1016/s2215-0366(16)00063-8
OpenAlex
W2339690572
Cited by
96
References
36
Citations by year
2026: 1 · 2025: 10 · 2024: 10 · 2023: 8 · 2022: 10 · 2021: 15 · 2020: 9 · 2019: 10 · 2018: 11 · 2017: 6 · 2016: 6
FWCI
14.73
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (submittedVersion)
Funders
National Institute for Health and Care Research (ACF-2013-06-006)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
Keywords
suicide, mental health services, service change, organizational factors, community mental health services, employee training, employee turnover, incident reporting, patient safety, suicide prevention
MeSH terms
England, Humans, Mental Health Services, Risk, State Medicine, Suicide

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