Annual report 2018: England, Northern Ireland, Scotland and Wales
Date of publication: October 2018
Our 2018 annual report provides findings relating to people who died by suicide or were convicted of homicide in 2006-2016 across all UK countries. Additional findings are presented on sudden unexplained deaths (SUD) under mental health care in England and Wales.
Our large and internationally unique database is a national case series of suicide, homicide and SUD by mental health patients over 20 years. This allows us to examine the circumstances surrounding these incidents and changes in trends over time, and to make recommendations for clinical practice and policy to improve safety in mental health care.
10 key elements for safer care for patients
Our ’10 ways to improve safety’ continue to reflect the evidence we have collected over several years on the features of clinical services that are associated with lower patient suicide rates. These include safer wards, personalised risk management and low staff turnover.
We continue to recommend a renewed emphasis on suicide prevention on in-patient wards, with the aim of re-establishing the previous rate of decrease in in-patient suicide. This could include:
- measures to improve the physical safety of wards, e.g. removing potential ligature points;
- ensuring care plans are in place during agreed leave;
- the development of nursing observation as a skilled intervention.
Service measures to reduce patient suicide risk
- follow-up of patients leaving in-patient care within 2-3 days of discharge;
- safe prescribing of opiates and psychotropic drugs;
- reducing alcohol and drug misuse, with specialist substance misuse and mental health services working closely together.
- the treatment of depression, following NICE guidance;
- developing services for self-harm care;
- improving services for people with a diagnosis of personality disorder;
- the care of females with complex problems.
Preventing suicide in students
We suggest preventing suicide in students requires specific measures, including:
- prevention, through promotion of mental health on campus;
- awareness of risk, including the fact that conventional risk factors for suicide, such as alcohol or drug misuse, may be absent;
- availability of support especially at times of risk, such as during exam months;
- strengthened links to NHS services, including mental health care.
We recommend the clinical measures most likely to help services prevent interpersonal violence are:
- reducing alcohol and drug misuse;
- maintaining treatment and contact in patients at risk of losing contact with services.