(Suicide within 12 months of contact with mental health services: national clinical survey)
(Mental disorder and clinical care in people convicted of homicide: national clinical survey)
(Suicide and homicide by people with mental illness)
About 1000 people who commit suicide each year (nearly a quarter of all suicides) and about 40 of those who commit homicide (about eight per cent of all UK homicides) have had some contact with the mental health services in the year before death suggest researchers in two papers in this week's BMJ. The team from the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, at the University of Manchester base their finding on detailed clinical data collected on a sample of people in England and Wales who committed suicide during a two year period or who committed homicide during 18 months.
The authors say that their amalgamated findings highlight problems of non-compliance with medication regimens, loss of contact between patients and mental health services and drug and alcohol misuse. They say that these problems emphasise the need to develop strategies for preventing such tragic incidents.
In an accompanying editorial Dr John Geddes from the Warneford Hospital in Oxford says that the full 1999 inquiry report 'Safer Services' makes 31 recommendations for changes in clinical practice. These include recommendations about training in risk assessment, documentation (including the introduction of "patient passports"), the use of specific drug and psychological treatments, reducing access to means of suicide and changes in the Mental Health Act to allow compulsory community treatment. He warns that policymakers should be cautious about implementing these wide-ranging recommendations. He says that there are substantial uncertainties largely unacknowledged in the report about the current knowledge about suicide prevention and he says that these uncertainties present a need for further research.
Geddes also suggests that individual local inquiries into homicide should be discontinued because they are retrospective and foster a simplistic notion of the preventability of homicides and suicides.
Professor Louis Appleby, Director, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, School of Psychiatry and Behavioural Sciences, University of Manchester, Withington Hospital, Manchester M20 8LR Louis.Appleby@man.ac.uk
Dr John Geddes, Honorary Consultant Psychiatrist, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford firstname.lastname@example.org Mental Health Services Should Aim to Improve Safety to Prevent Suicide and Homicide - But Retrospective Inquiries Should Be Discontinued About 1000 people who commit suicide each year (nearly a quarter of all suicides) and about 40 of those who commit homicide (about eight per cent of all UK homicides) have had some contact with the mental health services in the year before death, suggest researchers in two papers in this week's BMJ. An accompanying editorial suggests caution in implementing changes in clinical practice as listed in the 1999 inquiry report 'Safer Services'.