Several suicide prevention measures in mental health services are implied by these findings, including measures to improve compliance and prevent loss of contact with services. Inpatient facilities should remove structural difficulties in observing patients and fixtures that can be used in hanging. Prevention of suicide after discharge may require earlier follow up in the community. Better suicide prevention in psychiatric patients is likely to need measures to improve the safety of mental health services as a whole, rather than specific measures for people known to be at high risk.
Suicide might be prevented among in-patients by improving ward design and removing fixtures that can be used in hanging. Prevention of suicide after discharge requires early community follow-up and closer supervision of high-risk patients.
BackgroundSuicide prevention is a health service priority but the most effective
approaches to prevention may differ between different patient groups.AimsTo describe social and clinical characteristics in cases of suicide from
different age and diagnostic groups.MethodA national clinical survey of a 4-year (1996–2000) sample of cases of
suicide in England and Wales where there had been recent (< 1 year)
contact with mental health services (n=4859).ResultsDeaths of young patients were characterised by jumping from a height or
in front of a vehicle, schizophrenia, personality disorder, unemployment
and substance misuse. In older patients, drowning, depression, living
alone, physical illness, recent bereavement and suicide pacts were more
common. People with schizophrenia were often in-patients and died by
violent means. About athird of people with depressive disorder died
within a year of illness onset. Those with substance dependence or
personality disorder had high rates of disengagement from services.ConclusionsPrevention measures likely to benefit young people include targeting
schizophrenia, dual diagnosis and loss of service contact; those aimed at
depression, isolation and physical ill-health should have more effect on
elderly people.
Objectives To estimate the rate of mental disorder in those convicted of homicide and to examine the social and clinical characteristics of those with a history of contact with psychiatric services. Design National clinical survey. Setting England and Wales. Subjects Eighteen month sample of people convicted of homicide. Main outcome measures Offence related and clinical information collected from psychiatric court reports on people convicted of homicide. Detailed clinical data collected on those with a history of contact with psychiatric services.
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