During 2009-2019, over a quarter (29%) of patients died by suicide in acute care settings, including in-patients, post-discharge care and crisis resolution/home treatment. Of the estimated 67 suicides by mental health in-patients in 2019, half were on agreed leave. The highest number of post-discharge deaths occurred 3 days after discharge from psychiatric in-patient care.

We recommend clinical services address the ward environment (both physical and emotional), vigilance and the safety of leave arrangements before discharge. After hospital discharge, patients should be followed up within 72 hours of discharge. These recommendations are highlighted in our “10 ways to improve safety” toolkit.

During 2009-2019 there were 213 suicides by patients aged under 18, an average of 19 deaths per year. This represents 19% of general population suicides in this age group, a lower proportion than in older groups (27%). Recent numbers appear to be higher, reflecting the increase in general population suicides by people aged under 18.

We recommend that suicide prevention in young people should focus on access to services, with services ensuring they have the skills to address multiple co-existing difficulties, preventing and responding to self-harm, and specific diagnoses such as autism and eating disorders. We also suggest clinicians assessing risk consider enquiring about online experience.

There were 281 deaths per year in patients who had experienced recent economic adversity, i.e. financial problems, workplace problems or homelessness. These patients were more likely to be middle-aged men, unemployed, divorced or separated, and were more likely to have recent illness onset, especially depression, and alcohol and drug misuse than other patients.

We suggest clinical services should be aware of the features of those at suicide risk in the context of economic adversity and should work with organisations that support people facing debt or other financial problems.

Our findings show an increase in the number of patients with a comorbid physical illness since 2014, accounting for 25% of all patient suicides in 2009-2019 overall. The risk profile of these patients is not the same as for patients generally – they are older, common risk factors such as self-harm or alcohol/drug misuse are less often present, and a higher proportion are women.

We recommend clinical services should be aware of the risk from opioids prescribed for pain and we suggest clinicians assessing risk enquire about access to opioids available at home, particularly among older patients.

The majority of patients with a history of domestic violence were female. They were more often younger, single or divorced, living alone and unemployed than other women. Self-harm, previous alcohol or drug misuse and personality disorder diagnosis were more common in this group, potentially reflecting previous trauma or abuse.

We ask clinical services to be aware of the risk associated with domestic violence, especially in female patients, but also in men. We suggest clinicians assessing suicide risk should include experience or threat of domestic violence.

Findings from our real-time data collection of suspected suicide deaths in England during the pandemic show experiences such as anxiety, isolation, or disruption to care may have contributed to some suspected suicide deaths by mental health patients.

We suggest clinical services be aware of the need to maintain support for patients under the care of mental health services, particularly for patients who are anxious or isolated, or have experienced disruption to care.