National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Annual Report 2017

Annual Report 2017 Annual update of key figures on suicide, homicide, and sudden death Messages on safer care Final year 2015 (equates to ONS 2015-16) Final year contains estimates to allow for delayed returns

Collecting NCISH data All potential cases nationally (e.g. ONS, GRO (N. Ireland and Scotland), Homicide Index) Contact with mental health services Detailed data collection via questionnaire

Key findings: suicide

Suicide, 2005-2015 UK N England Wales Scotland N. Ireland General population 64,603 49,545 3,493 8,662 2,903 Patients 17,823 (28%) 13,576 (27%) 817 (23%) 2,652 (31%) 1,214 UK_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide rates in the general population, UK Highest rate in N. Ireland Falls in England, Wales & Scotland UK_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide rates in STP ‘footprint’ areas (2013-2015) Variation by geography Highest rates in north & south-west Lowest rates in London & south-central areas High rates also in rural areas

Trends in patient suicide

Patient suicides, England ENGLAND_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patient suicides, N. Ireland, Scotland & Wales UK_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patient suicide rates, England Falling rates but problem estimating patient numbers Changing clinical population ENGLAND_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patient suicide rates in males by age, England Highest rates in middle age Rates falling in all age groups ENGLAND_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Method of suicide

Patient suicide: main causes of death, England ENGLAND_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patient suicide method, UK Hanging commonest method & rising over 10 years Almost half died by hanging in 2015 Fall in self-poisoning UK_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide by self-poisoning, England Opiates main type of drug in fatal overdose Prescribed & illicit ENGLAND_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Changes in clinical settings

In-patient suicide, UK Slower fall in recent years: 39% in 2005-10 Similar pattern in rates in England (31% & 14%) Average 114 deaths per year since 2011 (89 in England) UK_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide under CRHT, England 2x as many suicides under CRHT as in in-patients ⅓ under CRHT for <1 week ⅓ recently discharged from hospital ENGLAND_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide <3 months of hospital discharge, England Downward trend in England and Scotland In the UK, 23% fall in 2011-2015 ENGLAND_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicides per week after discharge, England Peak risk in first 2 weeks In 1st week, highest number on days 2 and 3 ENGLAND_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Non-adherence or missed contact, England Downward trend despite rise in overall patient numbers 31% fall in non-adherence in 2010-2015 ENGLAND_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide in patient groups

Patient suicide: primary diagnoses, England ENGLAND_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patient suicide: eating disorders, UK 19 deaths per year 68% ill >5 years Self-harm common 7% specialist services UK_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patient suicide: autism spectrum disorder, UK 11 deaths per year 38% aged <25 Self-harm common Fewer with alcohol misuse UK_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patient suicide: dementia, UK 18 deaths per year 16% ill <1 year 56% physical illness Other risk factors less common UK_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide in carers, UK 938 (5%) deaths Average 85 deaths per year More likely to be female ¼ ill for <1 year Fewer common risk factors, e.g. alcohol/drug misuse UK_SUICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide in the Armed Forces, 2011-2015, UK 208 (3%) deaths by current/former members of Armed Forces Average 42 deaths per year Alcohol misuse common (57%) UK_SUICIDE (2011-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide in people aged under 25

Suicide in people aged under 25 Number of suicides at each age rises steadily in late teens/early 20s Themes of bereavement, bullying, exam stress 21% suicide-related internet use 39% no service contact ENGLAND, WALES, SCOTLAND_SUICIDE (2014-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patient homicide

Homicide, 2005-2015 UK N England Wales Scotland N. Ireland General population 7,404 6,004 283 915 202 Patients 835 (11%) 641 39 (14%) 137 (15%) 35 UK_HOMICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Homicide by patients, England Lower figures in recent years 11 stranger homicides per year in the UK & number falling ENGLAND_HOMICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patient homicide: primary diagnosis, England ENGLAND_HOMICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patient homicide: engagement, England Overall, 49% not receiving planned treatment Fall of ⅓ over report period ENGLAND_HOMICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Alcohol/drug misuse in patient homicides England Wales Scotland N. Ireland Alcohol misuse 73% 74% 91% 100% Drug misuse 78% 92% Alcohol and/or drug misuse 88% 87% 96% Most convicted patients also had alcohol or drug misuse problem UK_HOMICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Conviction & sentence of patient homicides UK_HOMICIDE (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Sudden unexplained death

Sudden unexplained deaths, England & Wales 27 deaths per year Deaths linked to cardiovascular & respiratory disorders 7 deaths/year in under 45s but recent fall: 9 in 2005-09 4 in 2011-15 ENGLAND & WALES_SUDS (2005-2015) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Clinical messages

Clinical messages (1) Acute care Diagnostic groups Renewed emphasis on ward safety improve physical environ. measures to reduce leaving ward Services to follow up within <3 days of hospital discharge Care plans in place on discharge Ending ‘out of area treatments’ Awareness of risk in patients with an eating disorder, ASD or dementia Access to specialist support

Reduce opiate overdose Patient homicides & courts Clinical messages (2) Reduce opiate overdose Alcohol & drug misuse Safer prescribing: short term supplies opiate-containing painkillers kept at home Greater focus on comorbid substance misuse in risk management MH services to work closely with substance misuse services Patient homicides & courts Appropriateness of sentencing for patients with severe mental illness

Improving safety – NCISH evidence

National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Website: http://www.manchester.ac.uk/nci - Follow link to National Confidential Inquiry Like us on Facebook https://www.facebook.com/pages/Centre-for-Mental-Health-and-Safety Follow us on Twitter https://twitter.com/NCISH_UK