1. National Confidential Inquiry into Suicide and Safety in Mental Health

2. Professor Louis Appleby
2018 NCISH Annual Report
Professor Louis Appleby

3. Annual Report 2018
Annual update of key figures on suicide, homicide, and sudden death
Messages on safer care
Final year 2016 (equates to ONS )
Final year contains estimates to allow for delayed returns
DONE

4. 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
DONE

5. Key findings: suicide

6. Suicide 2006-2016 Scotland 8,601 suicide deaths 2,658 (31%) patients
Northern Ireland
2,956 suicide deaths
794 (27%) patients
England
49,654 suicide deaths
13,698 (28%) patients
Wales
3,491 suicide deaths
781 (22%) patients
DONE
UK_SUICIDE ( )
© National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

7. Suicide rates in the general population, UK
Highest rate in Northern Ireland
Rate in England at historical low
UK_SUICIDE ( )
© National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

8. Age-specific suicide rates, UK
DONE
UK_SUICIDE ( )
© National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

9. Rates in STP ‘footprint’ areas
( )
Variation by geography
Highest rates in north &
south west
Lowest rates in London &
south-central areas
High rates in rural & coastal areas
DONE

10. Trends in patient suicide

11. Patient suicides, UK No change Falling Increased DONE
UK_SUICIDE ( )
© National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

12. Patient suicide rates, England
Falling rates. i.e. adjusted for more people under mental health care
ENGLAND_SUICIDE ( )
© National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

13. Method of suicide

14. main causes of death, England
Patient suicide:
main causes of death, England
ENGLAND_SUICIDE ( )
© National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

15. Patient suicide method, UK
Hanging commonest method
Fall in self-poisoning
Self-poisoning as common as hanging in Scotland
UK_SUICIDE ( )
© National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

16. Suicide by self-poisoning, England Deaths by self-poisoning (n=3,095)
 Substance N %
Opiates/opioids (prescribed & illicit)
- opiates only
- paracetamol/opiate compound
947
746
201
33%
26% 7%
Non-opiate analgesics
205
Antipsychotics
302
11%
Antidepressants
- tricyclics
- SSRI/SNRIs
- other antidepressants
587
271
260 56
21% 9% 2%
ENGLAND_SUICIDE ( )
© National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

17. Changes in clinical settings

18. In-patient suicide, England
Fall has slowed
31%
11%
Need to strengthen:
ward safety
care planning
ENGLAND_SUICIDE ( )
© National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

19. Suicide under CRHT, England
>2x as many suicides under CRHT as in in-patients
1/3 recently discharged from hospital
>1/3 under CRHT for <1 week
DONE 2x as many
ENGLAND_SUICIDE ( )
© National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

20. after discharge, England
Suicides per week
after discharge, England
Highest risk on day 3
ENGLAND_SUICIDE ( )
© National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

21. Alcohol & drug misuse, England
56% patients with either alcohol or drug misuse, UK
Minority under specialist services
What about this slight rise since 2015? Update commentary
ENGLAND_SUICIDE ( )
© National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

22. Themes in this year’s report

23. Suicide in female patients, UK
15,634 suicides by females over report period
38% were patients
½ aged years
UK_SUICIDE ( )
© National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

24. Suicide in female patients
Suicide by self-poisoning more common in women (35%)
74% history of self-harm, esp. younger women (89%)
Affective disorder & personality disorder most common diagnoses
42% history of self-harm & co-morbid condition
UK_SUICIDE ( )
© National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

25. recent history of self-harm
Patient suicide:
recent history of self-harm
29% patients had recent history of self-harm
76% seen as low risk
UK_SUICIDE ( )
© National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

26. Suicide in people aged <20
Themes of bereavement, bullying, physical health, self-harm
¼ suicide-related internet use
40% no service contact
PEOPLE YOUNGER THAN 20 ( )
© National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

27. Student suicide (aged 18-21),
England & Wales
12% were patients; lower than non-student patients (21%)
Highest risk in January & April
Low rates of some common risk factors, e.g. alcohol & drug misuse
Note-left it like this because of the report where this same graph is included
STUDENT_SUICIDE ( )
© National Confidential Inquiry into Suicide and Safety in Mental Health. All rights reserved.
Not to be reproduced in whole or part without the permission of the copyright holder.

28. Clinical messages

29. Reducing suicide by in-patients
Clinical messages (1)
Reducing suicide by in-patients
Safer care
Improving physical
safety on ward
Care plans in place
Strengthen nursing
observation
Follow-up within
2-3 days post-discharge
Safer prescribing
Reducing alcohol
& drug misuse

30. Clinical messages (2) Female patients Recent self-harm Treatment of
depression, following
guidelines
Improving personality
disorder services
Care of women with
complex problems
Rise of recent self-harm
Associated with age &
gender
Strong warning of
suicide risk

31. Clinical messages (3) Young people Promoting mental
health in education
Shared role for
frontline services
Availability of support
at times of risk

32. ‘10 ways’ to improve safety

33. Sudden unexplained death

34. Sudden unexplained deaths,
England & Wales
31 deaths on average per year
Linked to physical health, especially cardiovascular & respiratory diseases
¼ aged under 45
less physical ill-
health
more poly-
pharmacy
ENGLAND & WALES_SUDS ( )
© 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.

35. 20 Years of the
Homicide Inquiry 35

36. Patient homicides in the UK,
11% patients, 71 per year
6% schizophrenia, 37 per year
Around half followed loss of contact or treatment non-adherence
UK_HOMICIDE ( )
© 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.

37. Homicide: alcohol and drugs
Alcohol & drugs contribute to 45% of all homicides in England & Wales.
Most patients (89%) had co-existing substance misuse ( ).
Prevention should focus on individual & public health measures to influence alcohol & substance misuse. 37 37

38. Stranger homicide
24% of homicides the victim & offender were not known to each other.
Alcohol contributed to the offence in 54% and drugs in 24%.
Victims of patient homicide less likely to be strangers compared to non-patients

39. Victims of homicide
90 patient victims of homicide between , 30 per year.
Patients were 2.6 times more likely to be a victim of homicide.
32% of patient victims were killed by another patient. 39

40. National Confidential Inquiry into Suicide and Safety in Mental Health
@NCISH_UK