Ground-breaking study on suicide and homicide by people with mental illness
December 2006
A comprehensive analysis of suicide and homicide by people with mental illness in England and Wales, directed by Professor Louis Appleby of the Division of Psychiatry, was published on 4 December.
Avoidable Deaths is the report of the National Confidential Inquiry (NCI) into Suicide and Homicide by People with Mental Illness, a national project established at the University in 1996 which collects clinical information on suicides and homicides occurring under mental health services. It covers five years of data collection, the large number of cases allowing a uniquely comprehensive examination of detail.
The number of psychiatric in-patient suicides was found to have fallen, with 67 fewer in 2004 than in 1997, while the number of people with a history of mental illness convicted of homicide in the five years to December 2003 remains at approximately 50 per year.
Louis said: “This report provides definitive national figures on patient suicide and homicide, and describes the events preceding them and the problems and warning-signs on which future prevention must be based. Concerns have previously been expressed about the role of drug treatments and physical restraint in these deaths; now we have information on the number of cases and the circumstances in which they occur.
“We are also presenting our findings on sudden unexplained deaths on mental health wards for the first time, a new area of investigation for the Inquiry. Although it may be unrealistic to expect services to prevent all or even most of these, the overall conclusion is that many are avoidable.
“We hope that mental health services will find this information useful and constructive. The more we know about the circumstances of patient deaths the more we can do to prevent them, and make services even safer for patients, healthcare staff and carers.”
Avoidable Deaths: Key findings and recommendations
Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness at The University of Manchester.Study on suicide
Key findings and recommendations include:
- The number of suicides by psychiatric in-patients shows a downward trend with 67 fewer deaths in 2004 than in 1997
- Death on the ward by hanging/strangulation has fallen by 51% (27 cases) over the same period
- Patient deaths following non-compliance with treatment has fallen from 22% (929 cases) in the previous Inquiry report to 14% (813 cases)
- Services need to do more to prevent in-patients absconding; 227 (27%) of in-patient deaths occurring whilst the patient was off the ward without permission between April 2000 and December 2004
- Of the 1271 post-discharge suicides in the report, 192 (15%) occurred in the first week after discharge and 255 (22%) before the first follow up appointment. The transition from the ward back into the community should be carefully managed with agreed plans to address stressors that may be encountered, and mechanisms in place for patients to contact services if a crisis occurs
Study on homicide
Key findings and recommendations include:
- 9% of all homicides in England and Wales were by people with a history of mental illness between April 2000 and December 2003
- The number of homicide convictions by people with history of mental illness remains stable at approximately 50 per year. Homicides carried out by patients with a diagnosis of schizophrenia also remain steady at approximately 15 per year
- Random attacks on members of the public by people with mental illness, have remained at five per year, indicating that community care has not increased the risk to the general public
- Services should ensure that high-risk patients receive enhanced CPA (the Government’s Care Programme Approach), backed up by peer review in the most high-risk cases
Study on unexplained deaths
Key findings and recommendations include:
- The Inquiry identified 235 deaths in this category – approximately 41 per year between March 1999 and December 2004. 17 of these (7%) were patients from ethnic minorities.
- Six in-patients died following restraint. Of these, four died within one hour of restraint
- Services need to give greater priority to physical healthcare, particularly on in-patient units
- Services should further improve the safety of prescribing in particular avoiding potentially cardio-toxic drugs for patients with a history of heart or respiratory disease
- Strict standards for physical restraint should be adopted and reviewed after each incident
