People Who Die by Suicide Without Receiving Mental Health Services: A Systematic Review
Open accessAbstract
INTRODUCTION: The majority of people who die by suicide have never seen a mental health professional or been diagnosed with a mental illness. To date, this majority group has largely been ignored, with most existing research focusing on predictors of suicide such as past suicide attempts. Identifying the characteristics of people who die by suicide without receiving services, often with a fatal first attempt, is crucial to reduce suicide rates through guiding improvements to service pathways and "just in time" interventions. METHODS: In this systematic review, PsycInfo, PubMed, CINAHL, and Web of Science were searched for peer-reviewed articles published from 1980 to 1st March 2021. Included studies examined predictors of non-receipt of formal mental health services among people who died by suicide. Data were extracted from published reports and the quality of included studies was assessed using a modified version of the Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies. This review was registered with PROSPERO, CRD 42021226543. RESULTS: Sixty-seven studies met inclusion criteria, with sample sizes ranging from 39 to 193,152 individuals. Male sex, younger or older age, and rural location were consistently associated with non-receipt of mental health services. People not receiving mental health services were also less likely to have a psychiatric diagnosis, past suicidal behavior or contact with general health services, and more likely to use violent means of suicide. There was some evidence that minority ethnicity and psychosocial stressors were associated with service non-receipt. CONCLUSION: People who die by suicide without receiving mental health services are likely to have diverse profiles, indicating the need for multifaceted approaches to effectively support people at risk of suicide. Identifying the needs and preferences of individuals who are at risk of suicide is crucial in developing new support pathways and services, and improving the quality of existing services. SYSTEMATIC REVIEW REGISTRATION: http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021226543.
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Access to mental health services has been identified as a critical issue in several studies.
“Access to mental health services has been identified as a critical issue in several studies [19, 21, 26, 47].”
From Suicide among youth and young adults in Canada: bereaved parents' perspectives on the systems of care (2025) · cites this paper as [47]
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- Authors
- Tang, S., Reily, N. M., Arena, A. F., Batterham, P. J., Calear, A. L., Carter, G. L., Mackinnon, A. J., & Christensen, H.
- Affiliations
- Black Dog Institute (AU)
- Australian National University (AU)
- University of Newcastle Australia (AU)
- Corresponding author
- Tang, Samantha
- ORCID
- Venue
- Frontiers in Public Health
- Publisher
- Frontiers Media SA
- Published
- 2022-01-18
- Volume
- 9
- Pages
- 736948-736948
- ISSN
- 2296-2565 (ISSN-L)
- PMC
- PMC8804173
- OpenAlex
- W4205736259
- Cited by
- 89
- References
- 107
- Citations by year
- 2026: 12 · 2025: 23 · 2024: 24 · 2023: 21 · 2022: 9
- FWCI
- 3.22
- Type
- journal article
- Language
- en
- Update notices
- corrigendum (2025-06-27)
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ANU Open Research (Australian National University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Funders
- Medical Research Council
- National Health and Medical Research Council (1200195, 1173146, 1155614, 1158707)
- Medical Research Future Fund
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Keywords
- suicide, untreated mental illness, suicide risk factors, suicide attempts, rural residence, gender differences, ethnic minorities, psychosocial stressors, suicide prevention, service pathways
- MeSH terms
- Mental Disorders, Cross-Sectional Studies, Humans, Male, Mental Health Services, Rural Population
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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