1. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Annual Report 2015 #NCISH15

2. Annual report of key figures on suicide, homicide, and sudden death Final year 2013 (equates to ONS 2013-14) Final year contains estimates to allow for delayed returns UK-wide but focus on England because of larger numbers Recommendations for services National Confidential Inquiry: Annual Report 2015

3. KEY FINDINGS Suicide

4. National Confidential Inquiry: Suicide UK_SUICIDE © 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. UK (1996-2013) N England (1996-2013) N Wales (1996-2013) N Scotland (1997-2013) N N. Ireland (1997-2013) N General population 106,62983,0075,83114,0343,757 In contact with services 28,013 (26%) 21,665 (26%) 1,337 (23%) 3,964 (28%) 1,047 (28%)

5. Suicide rates in general population, UK UK_SUICIDE © 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.

6. Suicide rates in NHS areas (colour coded)

7. Patient suicide, UK //

8. Male suicides in the general population, all ages and 45-54 years

9. Change in male suicides in the general population and patients

10. Rise in male patient suicides Males Number of suicides *1,239 % change post 2006**29% Males aged 45-54 Number of suicides333 % change post 200673% * Average number in 2012-2013; ** percentage change between 2006 and 2012-2013

11. Acute mental health care

12. In-patient suicide, England

13. Suicide within 3 months of discharge, England UK_SUICIDE © 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.

14. Suicides per week following discharge, England UK_SUICIDE © 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.

15. Suicide following discharge from an out of area unit, England, (number=182) 2008-20132003-2007 UK_SUICIDE © 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.

16. Suicide under crisis resolution/home treatment, England

17. Characteristics of patients who died under crisis resolution/home treatment services Patient suicides under CR/HT 109 (37%) under CR/HT services for <1 week 795 (43%) lived alone 24 (22%) died within 3 months of discharge

18. Suicide method

19. Patient suicide method, England

20. Patient suicide method UK: opiates Unfilled markers = old Scottish death coding rules

21. 44% prescribed  36% for the patient  8% for someone else 21% methadone*  39% in Scotland 20% tramadol* Patient suicide method UK: opiates * Data are from 2012-13

22. Physical illness UK_SUICIDE © 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.

23. Patient suicide UK: major physical illness

24. 379 deaths per year 2,876 (88%) chronic Most common categories: neurological (20%) endocrine (17%) rheumatological/ orthopaedic (16%) Patient suicide UK (2005-2013): major physical illness

25. 87 deaths per year 664 (87%) chronic Most common categories: cardiovascular (24%) rheumatological/ orthopaedic (19%) neurological (18%) endocine (17%) Patient suicide UK (2005-2013): major physical illness, aged 65 and over

26. Working with families

27. Working with families, UK Contact 2338 (14%) Urgent referral by family 1,001 (6%) Contacted family after missed apt 866 (22%) Contacted for review 10,743 (66%)

28. UK_SUICIDE © 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. 94 (2%) patient deaths, average 31 per year 18 (6%) patient deaths, aged under 25 171 (4%) patient deaths average 57 per year Patient suicide: “pro-suicide” sites; significant dates (England, 2011-2013)

29. Sudden unexplained death UK_SUICIDE © 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.

30. Sudden unexplained death 33 per year 49% cardiovascular disease 27% respiratory disease 8% epilepsy 13% cerebrovascular disease 8% polypharmacy 12% BME group

31. Sudden unexplained death: patients aged under 45 96 (26%) 9 per year 23% cardiovascular disease 19% respiratory disease 13% epilepsy 16% polypharmacy 27% BME group

32. Homicide UK_SUICIDE © 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.

33. National Confidential Inquiry: Homicide UK (1996-2013) N England (1996-2013) N Wales (1996-2013) N Scotland (1997-2013) N N. Ireland (1997-2013) N General population 11,1779,4144431,431288 In contact with services 1,229 (11%)938 (10%)49 (11%)208 (15%)34 (12%)

34. Patient homicide, UK

35. Stranger homicide, UK average 142 per year 117 (7%) by patients, average 11 per year 103 (88%) patients had a history of alcohol/drug misuse

36. Stranger homicide, UK

37. Clinical messages (1) Suicide in male patients Rise in male suicide also found in patients Address risk factors: alcohol misuse isolation economic pressures Pressures on acute care Suicide in CR/HT increasing Review acute care, especially the use of CR/HT Stop acute admissions out-of- area

38. Clinical messages (2) Suicide by opiate overdose Opiates now commonest drugs used in fatal overdose Awareness of risk from access to opiates containing painkillers Limit duration and amount of prescribed opiates Working with families Closer working with families a key suicide prevention measure Early involvement with families and during discharge planning Make it easier for families to pass on concerns

39. Clinical messages (3) Physical illness Physical illness is a common antecedent of patient suicide Nearly half of patients over 65 who die by suicide also have a physical illness Address physical health needs in care plans and review with GP Sudden death No change in the number of young patients dying suddenly Young patients should: have physical health assessment, avoid polypharmacy Investigation for all younger deaths

40. 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