A fifth of suicides among mentally ill are preventable

The health service is being called on to step up efforts to protect people with mental health problems from harming themselves or other people after a report published this week showed that more than a fifth of suicides among people with mental illness could have been prevented.

About a quarter of the United Kingdom's 6500 suicides each year occur among people with mental illness, some 12% of them while in hospital, usually by hanging from a curtain rail.

The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness showed that many people at risk of suicide are simply slipping through the net.

A quarter of those who committed suicide died within three months of being discharged from hospital, nearly half of them never making it to their first follow up appointment.

The report showed that nearly 50% of the suicides in England and Wales were among people being supervised under the enhanced “care programme approach,” which requires input from a multidisciplinary team of mental health specialists. But half of them were not taking their medication when they died or had missed their last appointment with community services.

Professor Louis Appleby, director of the inquiry, said that these latest figures from 1999 suggest that the fall in the suicide rate among the general population, which has been observed since the beginning of the 1990s, is continuing. However, suicides among people with mental illness have remained static.

Mental illness also contributes to about a third of the 600 murders that occur in the UK each year, with alcoholism, drug misuse, and personality disorder topping the list of the most common diagnoses. Less than 10% of those of accused of homicide in England and Wales, however, had been in contact with mental health services in the previous year and only a third of these people were being supervised under the enhanced care programme approach.

According to the report, mental health teams thought few of the homicides could have been prevented. A record of violence was more common among those without mental illness than those with it; and people with mental illness are more likely to kill someone they know than those without mental illness.

The new inquiry has called for each country in the United Kingdom to develop a suicide prevention strategy and overhaul its care programme approach systems.

Hospital patients and those recently sent home should be more closely monitored, said the report, and any devices that may assist suicide, such as curtain rails, should be removed. National criteria for the enhanced care programme approach should be developed with precise guidance on what to do if patients fail to comply with treatment and miss appointments. In addition, the enhanced care programme approach should be applied more broadly to cover more patients who are at risk.

Finally the report recommended that the public should be reassured that people with mental illness are unlikely to kill strangers.

Safety First. Five Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness can be obtained from the inquiry office (tel 0161 291 4751) or from the Department of Health's website (http://www.doh.gov.uk/mentalhealth/safetyfirst).