Rise of suicides among males in mental health care
Carolyn Chew-Graham, RCGP Curriculum Adviser for Mental Health
A report by The University of Manchester’s National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH), published on 22 July, shows a large rise in suicide among male patients in mental health care, with a 29% rise among men who die by suicide while under the care of mental health services in the UK.
The largest rise was seen in middle aged (45-54 years old) men. There has been a 73% increase since 2006, which may be driven by increases in risk factors such as alcohol and economic pressures.
The NCISH report, commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the Clinical Outcome Review Programmes*, also highlighted the rise in deaths among patients treated under Crisis Resolution or Home Treatment (CR/HT) services as an alternative to in-patient admission. Suicides under CR/HT are now three times greater than the number of deaths occurring in mental health in-patient settings, with an estimated 226 deaths in 2013. The number of suicide deaths following discharge from a non-local in-patient unit has also risen in recent years.
The most common type of drug taken in fatal overdose by mental health patients is now opiates, causing 141 deaths in 2013 across the UK, and a total of 1,215 suicides over the study period. In around half of these deaths, the source of opiates is prescription, mainly for the patient, though sometimes for someone else. Those who died by opiate poisoning were more likely to have had a major physical illness than patients who used other methods.
This report has a number of implications for primary care:
- Primary care practitioners and partner agencies must address factors that add to risk of suicide in male patients, especially alcohol misuse, isolation and economic problems such as debt and unemployment.
- Male patients should be offered ‘talking treatments’ as well as drug treatments with clinicians pro-active in following patients up and monitoring risk.
- Where drugs (including anti-depressants, anti-psychotics and opioids) are prescribed, limited quantities should be given, poly-pharmacy should be avoided and ensure regular monitoring occurs.
- Communication between specialist and primary care should ensure seamless discharge from in-patient or crisis-resolution services.
- Where possible, primary care clinicians should work closely with families to support people at risk.
- Physical health needs, especially long-term needs, should be reflected in mental health care plans.
- Primary care clinicians need improved training in the management of people with mental health problems, and in suicide mitigation.
- Primary care clinicians need support and supervision to support patients appropriately.
- Improved liaison and communication is needed between primary and specialist care.
For more details please visit the HQIP website.
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH) was established at The University of Manchester in 1996. NCISH collects information on events leading to suicide, homicide or sudden unexplained death (SUD) in mental health patients and makes recommendations for prevention.
*The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. HQIP’s aim is to promote quality improvement, and it hosts the contract to manage and develop the Clinical Outcome Review Programmes, one of which is the Mental Health Clinical Outcome Review Programme, funded by NHS England, NHS Wales, the Health and Social Care Directorate of the Scottish Government, The Northern Ireland Department of Health, Social Services and Public Safety (DHSSPS), and the States of Jersey and Guernsey.
The programmes, which encompass confidential enquiries, are designed to help assess the quality of healthcare, and stimulate improvement in safety and effectiveness by systematically enabling clinicians, managers and policy makers to learn from adverse events and other relevant data. More details can be found here.