Between 1997 and 2006, 38% of out-of-clinic suicides by mental health patients were carried out by people absent without leave from the hospital. Researchers writing in the open access journal BMC Psychiatry suggest that measures to improve the ward environment or prevent patients from leaving psychiatric wards without staff agreement could avoid up to 50 suicide deaths every year.

Isabelle Hunt, from the University of Manchester, UK, worked with a team of researchers to investigate suicides in England and Wales over a ten-year period. There were 1,851 cases of suicide by current psychiatric in-patients, and 70% occurred off the ward. Four hundred and sixty-nine of these patients died after going absent without leave. Hunt said, "Compared to individuals who died when they were off the ward with staff agreement, those who absconded were more likely to be young, unemployed and homeless. Schizophrenia was the most common diagnosis, and rates of previous violence and substance misuse were high. Absconders were more likely than inpatients on agreed leave to have been legally detained for treatment, be non-compliant with medication, and to die in the first week of admission".

The researchers suggest that a more supportive environment, tighter control of ward exits and more intensive observation of patients, particularly in the early days of admission, might be one way to limit the likelihood of a patient taking their own life. According to Hunt, "It is clearly a challenge to prevent patients leaving a general psychiatry open ward. Our findings can, however, inform staff of the clinical characteristics associated with absconding suicides, such as schizophrenia, substance misuse and noncompliance".

Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey
Isabelle M Hunt, Kirsten Windfuhr, Nicola Swinson, Jenny Shaw, Louis Appleby, Nav Kapur and the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness
BMC Psychiatry (in press)
Article available at journal website:

Professor Louis Appleby is a co-author of the paper and is also the National Director of Mental Health for England. The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness is based at the University of Manchester and is funded by the National Patient Safety Agency, with further funding from the Scottish Government and the Department of Health, Social Services and Public Safety, Northern Ireland. The Inquiry publishes annual and 5-year reports, the latest of which, "Avoidable Deaths 2006", can be found on the Inquiry website

Graeme Baldwin
BioMed Central