Mental health patients are at their highest risk of dying by suicide in the first two weeks after leaving hospital - a report out today shows. Around 3,225 patients died by suicide in the UK within the first three months of their discharge from hospital - 18% of all patient suicides, between 2002-2012.
The University of Manchester's National Confidential Inquiry into Suicide and Homicide by People with Mental Illness found that 526 patients died within the first week, the peak time of risk in England, Northern Ireland and Scotland; it is the first two weeks in Wales.
The Inquiry data, commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England, the Health Department of the Scottish Government, the Welsh Government, DHSSPS Northern Ireland and Jersey, was being presented to healthcare professionals and service users at a launch event in Manchester today.
Professor Louis Appleby, Director of the National Confidential Inquiry, who led the study said: "Our latest data shows the first three months after discharge remain the time of highest risk but especially in the first 1-2 weeks.
"This increased risk has been linked to short admissions and to life events so our recommendations are that careful and effective care planning is needed including for patients before they are discharged and for those who self-discharge.
"Early follow-up appointments should be strengthened and reducing the length of in-patient stay to ease pressure on beds should not be an aim in itself. Instead health professionals should ensure the adverse events that preceded the admission have been addressed.
"The report also highlights 24 deaths in England and Wales in patients who had been restrained by ward staff in the previous 24 hours. 5 of these deaths occurred in 2012.
The research team call for suicides within 3 days of hospital discharge and deaths and serious injuries caused by restraint to be NHS 'never events'.
The National Confidential Inquiry at The University of Manchester presents data for England, Northern Ireland, Scotland and Wales from January 2002 to December 2012 based on date of death for suicide and date of conviction for homicide.
There were 18,017 patient suicides between 2002 and 2012 in the UK, 28% of suicides in the general population during this time. Hanging remains a common method for suicide with an increase in this method.
In 2012, there were 2,994 suicides by hanging in the UK, 813 in mental health patients.
Professor Nav Kapur, Head of Suicide Research at the National Confidential Inquiry, said: "The increase in hanging may be related to restrictions on the availability of other method and the misconception that hanging is a quick and painless way to die - but this is not the case and is also highly distressing for family members who discover the body.
"This method is difficult to prevent outside institutional settings but there is a broad responsibility for preventing suicide by this means. In particular it would be helpful for the media to ensure that in avoiding the depiction of full details of suicides by hanging, they do not inadvertently make it appear to be a non-traumatic method.
"The fall in homicides committed by mental health patients reported last year for England was sustained but there was no further fall. Between 2002-2012 828 people convicted of homicide in the UK have been confirmed as mental health patients, on average 75 per year. 66 homicides were recorded in 2012 in the UK.19% of all homicides were intimate partner homicides, 13% of perpetrators were mental health patients similar to the 11% figure for all homicides.
Professor Jenny Shaw, Head of Homicide Research on the Inquiry, said: "Mental health services need to recognise their role in preventing domestic violence, working with other agencies. We need to improve the mental health of perpetrators to protect victims."
UK charities call for better support for mental health patients after leaving hospital
The mental health charities Rethink Mental Illness and Mind have issued a joint response to the National Confidential Inquiry into Suicide and Homicide.
Paul Farmer, Chief Executive of Mind, said:
"It is shocking that so many suicides are occurring in just a few weeks after patients leave hospital. This is an important time in someone's steps towards recovery when they need quality help and support around them. We need to understand why this is happening and make sure that action is being taken to better support people after they are discharged from hospital.
"Mind's own research has shown that, in many parts of the country, crisis care teams are under-resourced, understaffed and overstretched. We have also heard about beds being cut and the sometimes desperate struggle that people face in finding a bed which can mean being sent miles away from home. We would be very concerned if this pressure on beds and budget cuts means that patients are now being discharged from hospital before they are ready, putting them at risk. With the General Election now under a year away, the next government needs to commit to increasing investment in mental health - there really isn't any room for belt tightening.
"It is upsetting to see that there were five deaths following incidents of restraint in 2012. Pinning someone face down on the floor is humiliating, dangerous and as these statistics show can be fatal. We have seen some welcome developments this year in working towards an end to face down restraint, particularly the new guidance about restraint issued earlier this year. We hope that with its implementation we will see an end to the use of face down restraint and that deaths and serious injuries can be made a 'never event' in the NHS."
Mark Winstanley, CEO of Rethink Mental Illness said:
"These new stats highlight the serious lack of support available to people with mental illness in the community. The fact that so many people take their own lives within two weeks of leaving hospital clearly shows that we need more services in place to help people recover from a crisis. Far too many people are also missing out on crucial treatments such as Early Intervention, which would make a huge difference in helping them avoid reaching crisis point in the first place.
"This is completely unacceptable. We know which services are most effective in helping people recover from mental illness, and offer the NHS significant long-term savings. Now we need the Government to invest in those services as an urgent priority. Not only will it save money, but more importantly it will save lives too.
"It's also really important to put into perspective the figures about homicides by people who use mental health services. Each and every death in these circumstances is absolutely tragic, and we do not in any way want to dismiss the pain caused to the individual families involved. But it is important that the public understand how small the real risk is. Violent crimes of any nature by people with mental illness are extremely rare, and these stats show that the numbers have decreased over the past few years.
"In fact, 95% of all homicides are committed by people who don't have a mental health problem. But because we often talk about conditions like schizophrenia in the context of a violent incident, it's created a false association between mental illness and violence. We don't hear about the vast majority of people with mental health problems who are quietly getting on with their lives and pose no threat to anyone."