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

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

3. 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

4. Key findings: suicide

5. 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 ( )
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6. Suicide rates in the general population, UK
Highest rate in N. Ireland
Falls in England, Wales & Scotland
UK_SUICIDE ( )
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7. 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

8. Trends in patient suicide

9. Patient suicides, England
ENGLAND_SUICIDE ( )
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10. Patient suicides, N. Ireland, Scotland & Wales
UK_SUICIDE ( )
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11. Patient suicide rates, England
Falling rates but problem estimating patient numbers
Changing clinical population
ENGLAND_SUICIDE ( )
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12. Patient suicide rates in males by age, England
Highest rates in middle age
Rates falling in all age groups
ENGLAND_SUICIDE ( )
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13. Method of suicide

14. Patient suicide: main causes of death, England
ENGLAND_SUICIDE ( )
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15. Patient suicide method, UK
Hanging commonest method & rising over 10 years
Almost half died by hanging in 2015
Fall in self-poisoning
UK_SUICIDE ( )
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16. Suicide by self-poisoning, England
Opiates main type of drug in fatal overdose
Prescribed & illicit
ENGLAND_SUICIDE ( )
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17. Changes in
clinical settings

18. 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 ( )
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19. 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 ( )
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20. Suicide <3 months of hospital discharge, England
Downward trend in England and Scotland
In the UK, 23% fall in
ENGLAND_SUICIDE ( )
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21. Suicides per week after discharge, England
Peak risk in first 2 weeks
In 1st week, highest number on days 2 and 3
ENGLAND_SUICIDE ( )
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22. Non-adherence or missed contact, England
Downward trend despite rise in overall patient numbers
31% fall in non-adherence in
ENGLAND_SUICIDE ( )
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23. Suicide in patient groups

24. Patient suicide: primary diagnoses, England
ENGLAND_SUICIDE ( )
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25. Patient suicide: eating disorders, UK
19 deaths per year
68% ill >5 years
Self-harm common
7% specialist services
UK_SUICIDE ( )
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26. Patient suicide: autism spectrum disorder, UK
11 deaths per year
38% aged <25
Self-harm common
Fewer with alcohol misuse
UK_SUICIDE ( )
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27. Patient suicide: dementia, UK
18 deaths per year
16% ill <1 year
56% physical illness
Other risk factors less common
UK_SUICIDE ( )
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28. 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 ( )
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29. 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 ( )
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30. Suicide in people aged under 25

31. 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 ( )
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32. Patient homicide

33. 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 ( )
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34. Homicide by patients, England
Lower figures in recent years
11 stranger homicides per year in the UK & number falling
ENGLAND_HOMICIDE ( )
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35. Patient homicide: primary diagnosis, England
ENGLAND_HOMICIDE ( )
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36. Patient homicide: engagement, England
Overall, 49% not receiving planned treatment
Fall of ⅓ over report period
ENGLAND_HOMICIDE ( )
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37. 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 ( )
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38. Conviction & sentence of patient homicides
UK_HOMICIDE ( )
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39. Sudden unexplained death

40. 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
4 in
ENGLAND & WALES_SUDS ( )
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41. Clinical messages

42. 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

43. 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

44. Improving safety – NCISH evidence

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