National Confidential Inquiry into Suicide and Homicide by People with Mental Illness
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National Confidential Inquiry into Suicide and Homicide by People with Mental Illness The Centre for Suicide Prevention University of Manchester, UK Kirsten Windfuhr, PhD Scottish Association of Mental Health (SAMH) Winter Conference 23 November 2010
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National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. The Centre for Suicide Prevention University of Manchester, UK Kirsten Windfuhr, PhD. Scottish Association of Mental Health (SAMH) Winter Conference 23 November 2010. Overview. Background - PowerPoint PPT Presentation
Transcript of National Confidential Inquiry into Suicide and Homicide by People with Mental Illness
National Confidential Inquiry into Suicide and Homicide by
People with Mental IllnessThe Centre for Suicide Prevention
University of Manchester, UK
Kirsten Windfuhr, PhD
Scottish Association ofMental Health (SAMH) Winter Conference
23 November 2010
Overview
• Background
• Aims & methodology
• Findings– general population– overall patient findings– finding relating to substance
misuse/dependence
• Summary of findings
Background
• Est. at the University of Manchester– 1996/97 (England/Wales)– 1997/98 Scotland, Northern Ireland
• Funders– Scottish Government– DHSSPS, N. Ireland– NPSA (England/Wales)
• Governance– national steering group
• Dissemination– Reports, papers, presentations
Aims
• Collect national data on suicide and homicide by people in care of services
– Contact in previous 12 months
– Priority groups (e.g. in-patients)
– Key clinical problems (e.g. lost contact)
• Recommend changes to practice and policy to reduce future risk
• Changes in rates/numbers over time
Methodology
Obtain national data
Determine contact with MH services via trust/health board contact
No contact within 12 months
Contact within 12 months
Send questionnaire toconsultant
Suicide (1998-2008)
• General population suicides: 9,279
• 843 per year (rate = 18.7 per 100,000)
General population suicides: age and sex profile
992
1723
1123
771
212 162
458
294
1565
291
506521
291 370
0
200
400
600
800
1000
1200
1400
1600
1800
2000
< 25 25-34 35-44 45-54 55-64 65-74 75+Age groups
Freq
uenc
yMale Female
Rates of general population suicide
9.89.39.4
10.010.610.610.610.6
11.211.7
12.4
19.8 19.9 19.7 19.5 19.8
17.618.7
17.118.2 18.2
16.8
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
22.0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008Year
Rat
e pe
r 10
0,00
0 po
pula
tion
England Scotland
Rates of suicide per 100,000 population (1998-2008)
4.5
11.612.8
22.1
24.8
27.4 27.4
24.922.7
19.9
1715.8
14.3
9.4
0.4
12.1
10.49.18.28.6
9.411.5
12.713.8
10
14.31413.812.4
1
10
12.511.8 11.8
0
5
10
15
20
25
30
Age
Rat
e pe
r 100
,000
pop
ulat
ion
England Scotland
General population suicide: method
339
281 290285
259
325
267
306283
317309
288
253277
236244
275
234259
285
246254
151528
1817303630566061
7580
8572
98
71
97
7179
87
905082
748572
80100
93
86
9193
0
50
100
150
200
250
300
350
400
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Freq
uenc
y
Hanging Self-poisoning CO poisoning Jumping Drowning
Patient suicide
Country N %
Scotland
(1998-2008)
2,522 27%
England
(1997-2007)
13,473 26%
Patient suicide: recent contact with mental health services
Patient suicide: age and sex profile
183
429
464
283
186
82
41
83
129
209183
121
86
43
0
50
100
150
200
250
300
350
400
450
500
< 25 25-34 35-44 45-54 55-64 65-74 75+
Freq
uenc
y
Age groups
Male Female
Number of patient suicides
226
274
208217
250246238238
208218
209
159176
136134
161164164142148147144
67
98
728389827496
607165
0
50
100
150
200
250
300
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Freq
uenc
y
Total Male Female
Number of patient suicides by age-group
2219 18
28
36
27 26 25 25
12
29
103107
113103
115121 120
132
100 102
120
8279
6158 54
67 6774 71
65
99
232229 23
20
23 26 22 27
12
26
0
10
20
30
40
50
60
70
80
90
100
110
120
130
140
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008Year
Fre
qu
ency
Under 25 25-44 45-64 65+
Patient suicide: method
87
68
100
6166
88
79
9284
78818168
97837590
87
71
84
59
76
54626101055810
27
1923
11
38
252626252027
17181625
20232722
26
19
26
0
10
20
30
40
50
60
70
80
90
100
110
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Freq
uenc
y
Hanging Self-poisoning CO poisoning Jumping Drowning
Patient suicide: Socio-demographic features
N
(N=2,522)
Percentage
Median age 41 (11-89)
Male sex 1,668 66%
Unmarried 1,839 75%
Living alone 1,170 49%
Unemployed 1,081 45%
Homeless 65 3%
Patient suicide: Behavioural features
History of:N
(N=2,522)
Percentage
Self-harm 1,691 68%
Violence 556 23%
Alcohol 1,427 58%
Drug 951 39%
Patient suicide: primary diagnosis
16 16
8 9
14
33
0
5
10
15
20
25
30
35
Schizophrenia Affectivedisorder
Alcoholdependence
Drugdependence
Personalitydisorder
Other
Per
cen
tag
e
Patient suicide: alcohol and drugs (%)
8
16
3
9
43
57
30
38
0
5
10
15
20
25
30
35
40
45
50
55
60
Alcohol dependence Drug dependence Alcohol misuse Drug misuse
England
Scotland
Note: Time period is 1998-2007
Patient suicide: contact with addictions services
No contact(N=82; 45%)
DrugDependence
(N=210)
Contact(N=165; 45%)
No contact(N=198; 55%)
Contact(N=100; 55%)
Alcohol Dependence
(N=406)
Patient suicide: characteristics compared to all other patients
More likely to:
Alcohol misuse/
dependence
Drug misuse/
dependence
Male √ √
Social adversity/isolation √ √
History of self-harm, violence √ √
Secondary diagnosis √ √
Multiple previous admissions √ √
Missed final contact √ √
Self-discharged √ √
Treatment refusal √
Long term risk moderate/high √
Patient suicide: characteristics compared to all other patients
Less likely to:
Alcohol misuse/
dependence
Drug misuse/
dependence
In-patient √ √
Short duration of illness √ √
Recent service contact √ √
Follow-up appointment √
Dual diagnosis
N=642
Other cases
N=1,855
Dual diagnosis 26%
history of violence 29% 21%
history of self-harm 74% 66%
treatment refusal 20% 10%
>5 previous admissions 29% 13%
in-patient 12% 8%
short duration of stay 23% 32%
recent service contact 47% 37%
Patient suicide: dual diagnosis
Mental health teams’ estimation of risk at last contact: long term risk
Prevention
• Less preventable compared to England– 11% v. 19%
• Prevention differed in different patient groups– more preventable
• affective disorder• recent contact with services• symptoms at final contact
– less preventable• alcohol dependence
Summary of findings
• General population
– higher rate compared to England
– fall in general population rate
– age differences• cohort effect
Summary of findings
• Patient suicide– higher compared to England
– prevention• limited prevention from mental health
services
– public health approach
Summary of findings
• Alcohol and drug misuse common – 1,427 alcohol misuse
• 129 deaths per year– 950 drug misuse
• 86 deaths/year– 642 dual diagnosis
• 58 deaths/year• Substance misuse contributes to pattern
of risk• Multiple social/clinical risk factors
• public health approach
Thank you
www.manchester.ac.uk/nci
National Confidential Inquiry staff:
Louis Appleby (Director) Harriet Bickley
Nav Kapur (Asst.Director) Cathryn Rodway
Jenny Shaw (Asst.Director) Alison Roscoe
Alyson Williams Pauline Turnbull
Mohammad Rahman Kelly Hadfield
Isabelle Hunt Bec Lowe
David While James Burns
Sandra Flynn Phil Stones
Paul Clarke Danni Matthews
Huma Daud
