According to new research published by The Lancet, there has been a substantial decrease in suicide rates among health authorities across England and Wales that adopted a new range of suicide recommendations. The recommendations were made by the National Confidential Inquiry (NCI) into Suicide and Homicide by People with Mental Illness in the 1990s, a project that is striving to monitor suicide and enhance health-care quality in the UK.
The study, led by Professor Nav Kapur, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness and Centre for Suicide Prevention, University of Manchester, UK, analyzed the effectiveness of the new recommendations by comparing the suicide rates before and after implementing them.
Some of the recommendations include:
- A 24 hour crisis team.
- A 7-day follow-up for patients discharged from inpatient care.
- Community support for patients.
- Informing criminal justice agencies.
- Multidisciplinary review and giving information to the family of the patient.
- Policy for patients not complying with treatment.
- Provide treatment for those with mental health problems and addiction.
- Removal of ligature points from wards.
- Training in the management of "suicide-risk" for front-line staff.
The implementation of the multidisciplinary review accounted for a drop of 11.6 before to 10.5 after, and using local policies on patients with dual diagnosis caused a drop from 10.6 before to 9.6 after.
Authorities that adopted between 7-9 of the recommendations had a suicide rate far lower than those which adopted less than 6, with 9.1 suicides per 10,000 patient contacts, compared to 11.0.
The areas that saw the most notable decrease in suicide rates after the recommendations (of up to 10% lower) were in the most deprived catchment areas.
The authors comment:
"Our findings suggest that aspects of provision of mental health services can affect suicide rates in clinical populations. Investigation of the relation between new initiatives and suicide could help to inform future suicide prevention efforts and improve safety for patients receiving mental health care."
"We believe our findings have implications for mental health services internationally, particularly those in the USA, Europe, and Australasia, which have also had an increased emphasis on community compared with inpatient treatment."
Dr Yeates Conwell and Carole Farley-Toombs, University of Rochester Medical Center, Rochester, NY, USA, say:
"We cannot take for granted that even the most seemingly obvious intervention designed to reduce suicide is necessarily effective without evidence, or even that the reduction of suicide is a shared public concern warranting allocation of substantial resources for its prevention. This study is important at each of these levels. To have an even greater effect, we need much more evidence."
Written by Joseph Nordqvist