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Cited by 470Suicide and Self-Harm StudiesPsychiatric care and mental health servicesHomicide, Infanticide, and Child Abuse

Suicide within 12 months of contact with mental health services: national clinical survey

Open access
Appleby, L., Shaw, J., Amos, T., McDonnell, R., Harris, C., McCann, K., Kiernan, K., Davies, S. +2 more·1999·BMJ
DOI 10.1136/bmj.318.7193.1235PMC PMC27859
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Abstract

OBJECTIVE: To describe the clinical circumstances in which psychiatric patients commit suicide. DESIGN: National clinical survey. SETTING: England and Wales. SUBJECTS: A two year sample of people who had committed suicide, in particular those who had been in contact with mental health services in the 12 months before death. MAIN OUTCOME MEASURES: Proportion of suicides in people who had had recent contact with mental health services; proportion of suicides in inpatients; proportion of people committing suicide and timing of suicide within three months of hospital discharge; proportion receiving high priority under the care programme approach; proportion who were recently non-compliant and not attending. RESULTS: 10 040 suicides were notified to the study between April 1996 and March 1998, of whom 2370 (24%; 95% confidence interval 23% to 24%) had had contact with mental health services in the year before death. Data were obtained on 2177, a response rate of 92%. In general these subjects had broad social and clinical needs. Alcohol and drug misuse were common. 358 (16%; 15% to 18%) were psychiatric inpatients at the time of death, 21% (17% to 25%) of whom were under special observation. Difficulties in observing patients because of ward design and nursing shortages were both reported in around a quarter of inpatient suicides. 519 (24%; 22% to 26%) suicides occurred within three months of hospital discharge, the highest number occurring in the first week after discharge. 914 (43%; 40% to 44%) were in the highest priority category for community care. 488 (26% excluding people whose compliance was unknown; 24% to 28%) were non-compliant with drug treatment while 486 (28%; 26% to 30%) community patients had lost contact with services. Most people who committed suicide were thought to have been at no or low immediate risk at the final service contact. Mental health teams believed suicide could have been prevented in 423 (22%; 20% to 24%) cases. CONCLUSIONS: Several suicide prevention measures in mental health services are implied by these findings, including measures to improve compliance and prevent loss of contact with services. Inpatient facilities should remove structural difficulties in observing patients and fixtures that can be used in hanging. Prevention of suicide after discharge may require earlier follow up in the community. Better suicide prevention in psychiatric patients is likely to need measures to improve the safety of mental health services as a whole, rather than specific measures for people known to be at high risk.

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  • Suicide risk is particularly high when patients are discharged from psychiatric hospitals where the average length of stay is between 5 and 7 days.

    “the suicide risk is particularly high when the patients were discharged from psychiatric hospitals where the average LOS is between 5 to 7 days (Appleby et al., 1999; Goldacre et al., 1993).”

    From Time in treatment: Examining mental illness trajectories across inpatient psychiatric treatment (2020) · cites this paper as Appleby et al., 1999

    The “Suicide after discharge” passage (page not specified) reports that suicides peaked in the first week after discharge and that these cases were more often associated with final admissions lasting fewer than seven days. It does not report an average hospital length of stay of five to seven days; the claim appears to conflate length of admission with timing after discharge. (LLM, conf=0.87)

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  • Patients who are psychiatrically hospitalized for a suicide attempt or suicidal ideation are at very high risk for suicide following discharge, with rates of suicide shortly postdischarge more than 100 times greater than the rate in the general population.

    “Patients who are psychiatrically hospitalized for a suicide attempt or suicidal ideation (SI) are at very high risk for suicide following discharge [1 -3], with rates of suicide shortly postdischarge more than 100 times greater than the rate in the general population [4].”

    From Feasibility and utility of positive psychology exercises for suicidal inpatients (2014) · cites this paper as [2]

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Research works printed but not linked: 3

  1. Harris EC, Barraclough B. Suicide as an outcome for mental disorders. Br J Psychiatry 1997;170:205-28.
  2. Goldacre M, Seagroatt V, Hawton K. Suicide after discharge from psychi- atric in-patient care. Lancet 1993;342:283-6.
  3. Hawton K, Appleby L, Platt S, Foster T, Cooper J, Malmberg A, et al. The psychological autopsy approach to studying suicide: a review of method- ological issues. J Affect Disord 1998;50:269-76.

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Authors
Appleby, L., Shaw, J., Amos, T., McDonnell, R., Harris, C., McCann, K., Kiernan, K., Davies, S., Bickley, H., & Parsons, R.
Affiliations
University of Manchester (GB)
Corresponding author
Appleby, L.
ORCID
Venue
BMJ
Publisher
BMJ
Published
1999-05-08
Volume
318
Issue
7193
Pages
1235-1239
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.318.7193.1235
PMC
PMC27859
OpenAlex
W2168287347
Cited by
469
References
16
Citations by year
2026: 1 · 2025: 10 · 2024: 12 · 2023: 8 · 2022: 8 · 2021: 20 · 2020: 26 · 2019: 20 · 2018: 12 · 2017: 15 · 2016: 22 · 2015: 19 · 2014: 20 · 2013: 22 · 2012: 22
FWCI
23.58
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
Keywords
Care Programme Approach, medication adherence, psychiatric inpatients, suicide prevention, post-discharge follow-up, alcohol and drug abuse, hanging
MeSH terms
Suicide Prevention, Adolescent, Adult, Aged, Aged, 80 and over, Cause of Death, Deinstitutionalization, England, Female, Health Surveys, Hospitalization, Humans, Male, Mental Health Services, Middle Aged, Patient Acceptance of Health Care, Suicide, Time Factors, Wales, Survival Rate, Treatment Refusal

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