National Confidential Inquiry into Suicide and Homicide by People with Mental Illness

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National Confidential Inquiry into Suicide and
Homicide by People with Mental Illness

• The Centre for Suicide Prevention
• University of Manchester, UK
• Kirsten Windfuhr, PhD

Scottish Association of Mental Health (SAMH)
Winter Conference 23 November 2010
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Overview

• Background
• Aims methodology
• Findings
• general population
• overall patient findings
• finding relating to substance misuse/dependence
• Summary of findings

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Background

• Est. at the University of Manchester
• 1996/97 (England/Wales)
• 1997/98 Scotland, Northern Ireland
• Funders
• Scottish Government
• DHSSPS, N. Ireland
• NPSA (England/Wales)
• Governance
• national steering group
• Dissemination
• Reports, papers, presentations

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Aims

• Collect national data on suicide and homicide by
  people in care of services
• Contact in previous 12 months
• Priority groups (e.g. in-patients)
• Key clinical problems (e.g. lost contact)
• Recommend changes to practice and policy to
  reduce future risk
• Changes in rates/numbers over time

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Methodology
Obtain national data
Determine contact with MH services via
trust/health board contact
No contact within 12 months
Contact within 12 months
Send questionnaire to consultant
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www.manchester.ac.uk/nci
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Suicide (1998-2008)

• General population suicides 9,279
• 843 per year (rate 18.7 per 100,000)

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General population suicides age and sex profile
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Rates of general population suicide
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Rates of suicide per 100,000 population
(1998-2008)
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General population suicide method
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Patient suicide
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Patient suicide recent contact with mental
health services
Country N
Scotland (1998-2008) 2,522 27
England (1997-2007) 13,473 26
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Patient suicide age and sex profile
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Number of patient suicides
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Number of patient suicides by age-group
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Patient suicide method
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Patient suicide Socio-demographic features
N (N2,522) Percentage
Median age 41 (11-89)
Male sex 1,668 66
Unmarried 1,839 75
Living alone 1,170 49
Unemployed 1,081 45
Homeless 65 3
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Patient suicide Behavioural features
History of N (N2,522) Percentage
Self-harm 1,691 68
Violence 556 23
Alcohol 1,427 58
Drug 951 39
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Patient suicide primary diagnosis
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Patient suicide alcohol and drugs ()
Note Time period is 1998-2007
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Patient suicide contact with addictions services
Contact (N165 45)
Alcohol Dependence (N406)
No contact (N198 55)
Contact (N100 55)
Drug Dependence (N210)
No contact (N82 45)
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Patient suicide characteristics compared to all
other patients
More likely to Alcohol misuse/ dependence Drug misuse/ dependence
Male v v
Social adversity/isolation v v
History of self-harm, violence v v
Secondary diagnosis v v
Multiple previous admissions v v
Missed final contact v v
Self-discharged v v
Treatment refusal v
Long term risk moderate/high v
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Patient suicide characteristics compared to all
other patients
Less likely to Alcohol misuse/ dependence Drug misuse/ dependence
In-patient v v
Short duration of illness v v
Recent service contact v v
Follow-up appointment v
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Patient suicide dual diagnosis
Dual diagnosis N642 Other cases N1,855
Dual diagnosis 26
history of violence 29 21
history of self-harm 74 66
treatment refusal 20 10
gt5 previous admissions 29 13
in-patient 12 8
short duration of stay 23 32
recent service contact 47 37
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Mental health teams estimation of risk at last
contact long term risk
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Prevention

• Less preventable compared to England
• 11 v. 19
• Prevention differed in different patient groups
• more preventable
• affective disorder
• recent contact with services
• symptoms at final contact
• less preventable
• alcohol dependence

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Summary of findings

• General population
• higher rate compared to England
• fall in general population rate
• age differences
• cohort effect

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Summary of findings

• Patient suicide
• higher compared to England
• prevention
• limited prevention from mental health services
• public health approach

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Summary of findings

• Alcohol and drug misuse common
• 1,427 alcohol misuse
• 129 deaths per year
• 950 drug misuse
• 86 deaths/year
• 642 dual diagnosis
• 58 deaths/year
• Substance misuse contributes to pattern of risk
• Multiple social/clinical risk factors
• public health approach

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Thank you

• www.manchester.ac.uk/nci
• National Confidential Inquiry staff
• Louis Appleby (Director) Harriet Bickley
• Nav Kapur (Asst.Director) Cathryn Rodway
• Jenny Shaw (Asst.Director) Alison Roscoe
• Alyson Williams Pauline Turnbull
• Mohammad Rahman Kelly Hadfield
• Isabelle Hunt Bec Lowe
• David While James Burns
• Sandra Flynn Phil Stones
• Paul Clarke Danni Matthews
• Huma Daud