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Falling suicide rate linked to improving NHS mental health care

Service changes linked with 20-30% decrease in suicide rate

Adrian O'Dowd

Thursday, 21 April 2016

Changes to how mental health care is being provided in the NHS in England in recent years may be linked to a fall in the nation’s suicide rate, according to new research* published today in The Lancet Psychiatry.

However, researchers also found that suicide rates were higher in mental health trusts with higher levels of staff turnover.

Previous studies that have examined which aspects of mental health service provision are most effective in preventing suicide are scarce and have led to inconsistent findings.

Therefore, researchers at the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness at the University Manchester decided to carry out a study looking at the impact of specific mental health service improvements on suicide rates.

The researchers surveyed the medical directors of all mental health services in the NHS to establish the extent to which implementation of 16 suicide prevention recommendations and service changes in all NHS mental health services across England had reduced suicide rates between 1997 and 2012.

They also looked at whether suicide deaths were related to the way mental health services were organised using measures such as staff turnover, staff and patient satisfaction and patient complaints.

The research included data from 19,248 individuals who died by suicide in England over the 16-year period and were in contact with mental health services in the 12 months before they died.

For the study, the researchers compared suicide rates before and after these recommendations and service changes were introduced.

By 2012, 58 services (94%) had implemented at least 10 of the service changes and 34 (55%) had implemented all 16.

The researchers found that each of the 16 recommendations and service changes were linked with 20-30% decrease in the suicide rate – from around 12 suicides per 10,000 contacts with mental health services to approximately nine.

The five mental health service changes linked to the biggest falls in suicide were:

  • increasing the availability of specialist community services like crisis resolution and home treatment
  • better management of patients with dual diagnosis (such as drug or alcohol misuse as well as major mental illness)
  • reviews and information with families after suicide
  • introducing policies to help manage the transition to adult mental health services for young people
  • implementing NICE guidelines on depression

The study also linked suicide rates to some wider organisational factors including higher levels of non-medical staff turnover and reporting of patient safety incidents.

Professor Nav Kapur, lead author and head of suicide research at the Centre for Suicide Prevention at the University of Manchester, said: “Our study suggests that many of these interventions may prevent suicide and save lives. The data also show that at least as important as these initiatives might be the organisational context in which they are introduced.

“A workforce that is constantly changing is likely to affect the continuity of care and this could compromise safety.”

Professor Louis Appleby, director of the National Confidential Inquiry and one of the co-authors of the study, added: “This study shows that how clinical staff work can make a difference to patient suicide risk.”


* Prof Nav Kapur, et al. Mental health service changes, organisational factors, and patient suicide in England in 1997–2012: a before-and-after study. The Lancet Psychiatry, April 2016, doi: 10.1016/S2215-0366(16)00063-8

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