National Confidential Inquiry into Suicide and Homicide by People with Mental Illness

1. 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

2. Overview • Background • Aims & methodology • Findings • general population • overall patient findings • finding relating to substance misuse/dependence • Summary of findings

3. 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

4. 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

5. 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 to consultant

6. www.manchester.ac.uk/nci

7. Suicide (1998-2008) • General population suicides: 9,279 • 843 per year (rate = 18.7 per 100,000)

8. General population suicides: age and sex profile

9. Rates of general population suicide

10. Rates of suicide per 100,000 population (1998-2008)

11. General population suicide: method

12. Patient suicide

13. Patient suicide: recent contact with mental health services

14. Patient suicide: age and sex profile

15. Number of patient suicides

16. Number of patient suicides by age-group

17. Patient suicide: method

18. Patient suicide: Socio-demographic features

19. Patient suicide: Behavioural features

20. Patient suicide: primary diagnosis

21. Patient suicide: alcohol and drugs (%) Note: Time period is 1998-2007

22. Patient suicide: contact with addictions services Contact (N=165; 45%) Alcohol Dependence (N=406) No contact (N=198; 55%) Contact (N=100; 55%) Drug Dependence (N=210) No contact (N=82; 45%)

23. Patient suicide: characteristics compared to all other patients

24. Patient suicide: characteristics compared to all other patients

25. Patient suicide: dual diagnosis

26. Mental health teams’ estimation of risk at last contact: long term risk

27. 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

28. Summary of findings • General population • higher rate compared to England • fall in general population rate • age differences • cohort effect

29. Summary of findings • Patient suicide • higher compared to England • prevention • limited prevention from mental health services • public health approach

30. 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

31. 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