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 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 to consultant

Suicide ( ) General population suicides: 9, per year (rate = 18.7 per 100,000)

General population suicides: age and sex profile

Rates of general population suicide

Rates of suicide per 100,000 population ( )

General population suicide: method

Patient suicide

CountryN% Scotland ( ) 2,52227% England ( ) 13,47326% Patient suicide: recent contact with mental health services

Patient suicide: age and sex profile

Number of patient suicides

Number of patient suicides by age-group

Patient suicide: method

Patient suicide: Socio-demographic features N (N=2,522) Percentage Median age41 (11-89) Male sex1,66866% Unmarried1,83975% Living alone1,17049% Unemployed1,08145% Homeless653%

Patient suicide: Behavioural features History of: N (N=2,522) Percentage Self-harm1,69168% Violence55623% Alcohol1,42758% Drug95139%

Patient suicide: primary diagnosis

Patient suicide: alcohol and drugs (%) Note: Time period is

Patient suicide: contact with addictions services No contact (N=82; 45%) Drug Dependence (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 diagnosis26% history of violence29%21% history of self-harm74%66% treatment refusal20%10% >5 previous admissions29%13% in-patient12%8% short duration of stay23%32% recent service contact47%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 National Confidential Inquiry staff: Louis Appleby (Director)Harriet Bickley Nav Kapur (Asst.Director)Cathryn Rodway Jenny Shaw (Asst.Director)Alison Roscoe Alyson WilliamsPauline Turnbull Mohammad RahmanKelly Hadfield Isabelle HuntBec Lowe David WhileJames Burns Sandra FlynnPhil Stones Paul ClarkeDanni Matthews Huma Daud