Better NHS services reduce suicide rates

Researchers at The University of Manchester have for the first time shown a positive link between improvements in mental health services and a reduction in suicide rates.

Their research is published in The Lancet today (Thursday) in a study by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, based at the University's Centre for Mental Health and Risk.

Using nine national recommendations for safer services made by the National Confidential Inquiry, researchers compared the rates of suicide in NHS Mental Health Trusts before and after the recommendations were adopted.

They also compared suicide rates in Trusts that adopted few of the recommendations with those that adopted many.

The study shows that:

• Trusts that implemented between seven and nine of the key recommendations had lower suicide rates than those that implemented six or fewer.
• Recommendations that produced the biggest drop in suicide rates, when implemented, were the introduction of 24-hour crisis teams, policies for drug and alcohol misuse, and multi-disciplinary reviews after a suicide.

The study also shows that the growing use of the recommendations is linked to a reduction in suicides in specific patient groups.

• A reduction in in-patient suicides was associated with the removal of ligature points in hospitals.
• A reduction in suicides among patients with a history of missed contact with services was associated with assertive outreach services, designed to keep in touch with them after they left hospital.

Trusts that did not implement the recommendations saw little reduction in suicide rates.

The National Confidential Inquiry has been collecting and studying data on suicides by people in contact with mental health services in the UK since 1997. This study focused on the 12,881 suicides in 91 mental health services in England and Wales between 1997 and 2006. This represents 26% of all suicides in England and Wales during this time.

Nav Kapur, Professor of Psychiatry and Population Health and one of the authors of the paper, said: "These are really important findings for suicide research and mental health services internationally. No other studies have been able to show what impact specific mental health service improvements have on suicide rates.

"For most of the nine recommendations, services that implemented them had a decreased suicide rate after implementation. The results show that NHS services and mental health professionals are likely to have contributed to the prevention of suicide and the saving of lives."

Professor Louis Appleby, Director of the National Confidential Inquiry, said: "The community care reforms of the last decade seem to have had a positive impact on patient suicide - providing more intensive support to the most vulnerable patients appears to have improved their survival."

Dr Peter Byrne, Associate Registrar at the Royal College of Psychiatrists, said: "We welcome this excellent study showing how local implementation of comprehensive mental health services reduces the number of people who die by suicide. It proves the value of investing in safe psychiatric wards, close follow-up of discharged patients and specialised teams. In these difficult financial times, it is wrong to cut back on these essential mental health services when we need them the most."