Experts on bmj.com today warn that the increasing use of “narrative verdicts” made by coroners in England and Wales may lead to greater underestimation of suicide rates. The on-going research is partly funded by the National Institute for Health Research (NIHR).
In 2009 suicides accounted for 4,648 deaths in England and Wales. At present, official statistics produced by the Office for National Statistics (ONS) are based on open verdict deaths, also known as “short-from” verdicts, issued by coroners after inquests into unexpected or unnatural deaths.
According to Professor David Gunnell at the University of Bristol and his colleagues from the Universities of Oxford and Manchester there is a pressing need for changes to ensure that national suicide statistics will be reliable in the future.
Since 2001, increasing numbers of coroners have summarized inquest findings in several sentences by writing a “narrative verdict” that records how and in what circumstances death occurred rather than issuing a short form verdict and although narrative verdicts have some advantages, they often omit to mention intent. The authors say that the ONS can encounter problems in categorizing deaths with no clear intents and therefore classifies them as ‘accidental’.
Between 2001 and 2009 the number of narrative verdicts increased from 111 to 3,012, which is more than 10% of all inquests, with figures for 2010 suggesting that the numbers continue to increase.
According to the ONS suicide rates would have been underestimated by 6% in 2009, if all narrative coroners’ verdicts for deaths by hanging or poisoning that were coded as accidents were in fact suicides. This is a difference comparable to nearly a third of the National Suicide Prevention Strategy’s 20% reduction target and may only be a moderate assessment, as not all common suicide methods were included in the ONS analysis.
The authors warn that with rising numbers of narrative verdicts, underestimations may also rise simultaneously, resulting in false suicide rate estimates, which consequently lead to incorrect evaluations of national and local prevention activities that cover-up the effects of the current economic crisis on suicide.
At present, the Coroners’ Society of England and Wales is examining strategies to improve the current situation whilst the ONS is reviewing the coding of narrative verdicts.
Gunnell and his team point out that suicide statistics for the periods of time with increased narrative verdicts “should be treated with caution,” and that reliable statistics are vital for public health surveillance. The authors conclude saying that although changes are urgently needed, the current Government’s suggested abolition of the post of chief coroner “is likely to delay the implementation of recommended improvements and the development of consistent practice across the country.”
Written by Petra Rattue