Diagnosis and service contact of mental health patients who died by suicide

On this page:

• Diagnosis
  • Primary diagnoses of mental health patients who died by suicide (UK and Jersey, 2012-2022)
  • Main primary diagnoses of mental health patients who died by suicide in the UK and Jersey
• Contact with services
  • Timing of last contact with mental health services by patients who died by suicide (UK and Jersey, 2012-2022)
• Clinical setting
  • Service characteristics of mental health patients who died by suicide (UK and Jersey, 2012-2022)
• In-patient suicide
  • Number of mental health in-patients who died by suicide and number who died by hanging/strangulation/asphyxiation on the ward in the UK and Jersey
• Mental health patients who died by suicide after recent discharge
  • Number and rate of mental health patients who died by suicide within 3 months of in-patient discharge in the UK and Jersey
    
  • Number of mental health patient deaths by suicide per week following discharge (UK and Jersey, 2012 -2022)
    
  • Number of mental health patient deaths by suicide per day in the week following discharge (UK and Jersey, 2012-2022)
    

Diagnosis of mental health patients who died by suicide

Suicide by patients with affective disorder (bipolar disorder and depressive illness) has generally been falling, although we estimate an increase in 2021-2022. The number of patients with schizophrenia and other delusional disorders has been lower since 2017 than in earlier years of the report.

The number of suicide deaths in patients given a diagnosis of personality disorder increased in 2018-2020 but may have fallen in 2021-2022. Suicide by patients with anxiety disorders rose by 59% between 2012 and 2022; the increase was seen in those aged 25-44 and those aged 45-64. The number of patients with alcohol or drug dependence/misuse who died by suicide fell after 2013 and has continued to fall.

There were 386 (2%) patients with any diagnosis (primary or secondary) of autism spectrum disorder and 207 (1%) with attention deficit hyperactivity disorder (ADHD) who died by suicide; these numbers have increased since 2018 and recent figures show they account for approximately 60 and 40 deaths respectively each year. There were differences in the younger age groups. In patients aged 18-24, 8% had a diagnosis of autism spectrum disorder and in those aged under 18 this was 18%; 3% of those aged 18-24 had a diagnosis of ADHD compared to 7% of those aged under 18.

Primary diagnoses of mental health patients who died by suicide (UK and Jersey, 2012-2022)

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Main primary diagnoses of mental health patients who died by suicide in the UK and Jersey

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Contact with services by mental health patients who died by suicide

Nearly half (8,012, 46%) had been in contact with services in the week before death. At the final service contact, the immediate risk of suicide was viewed as not present or low in the majority of patients (12,124, 81%).

Timing of last contact with mental health services by patients who died by suicide (UK and Jersey, 2012-2022)

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Clinical settings of mental health patients who died by suicide

During 2012-2022, there were 4,718 patients (27%) who died by suicide in acute care settings (in-patients, under crisis resolution/home treatment, recently discharged from in-patient care), an average of 429 deaths per year. The proportion under acute care has fallen in 2019-2022 (25%) compared to 2012-2015 (30%).

Service characteristics of mental health patients who died by suicide (UK and Jersey, 2012-2022)

There were 250 patients who died by suicide having been subject to a Community/Compulsory Treatment Order (CTO) at some time in 2012-2022. This accounts for 1% of all patient suicides, an average of 23 deaths per year. Around a third (86, 35%) were no longer under the CTO at the time of suicide.

There were 310 patients under the care of an assertive outreach service, 2% of all patient suicide, an average of 28 deaths per year.

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In-patient suicide

In-patient deaths include those that occur physically on the ward and those that occur off the ward (e.g. during authorised or unauthorised leave).

There were 1,004 in-patient deaths by suicide in 2012-2022, representing 5% of patient suicides overall during this time period. This percentage has decreased since 2016, dropping to 4% in 2022. 22 (2%) were aged under 18 and 92 (10%) were aged 18-24.

There was a 41% fall in the number of in-patients who died by suicide between 2012 and 2022, although figures in 2020-2022 have not fallen. We also found rates of in-patient suicide per 10,000 admissions fell by 33% in 2012-2022, i.e. taking into account the total number of in-patient admissions in the UK.

Over a third (353, 40%) died on the ward; half (432, 50%) had left the ward with staff agreement; and 87 (10%) had left the ward without staff agreement or left with agreement but failed to return. There was a 31% increase in the proportion of in-patients who died on the ward in 2019-2022 compared to in 2012-2015 (47% v. 36%). The increase was seen in those aged under 25 (20, 61% v. 17, 39%). The majority (316, 90%) were by hanging/strangulation/asphyxia; the number of these deaths fell in 2012-2017 but have since remained stable and account for an average of 30 deaths per year.

Overall, a third (301, 34%) had been detained under Mental Health Act powers, half (152, 51%) of whom died on the ward compared to a third (198, 33%) of voluntary in-patients.

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Number of mental health in-patients who died by suicide and number who died by hanging/strangulation/asphyxiation on the ward in the UK and Jersey

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Mental health patients who died by suicide after recent discharge

There were 2,317 patients who died by suicide within 3 months of discharge from in-patient care, 13% of all patient suicide deaths, an average of 211 deaths per year. 13 (1%) were aged under 18 and 165 (8%) were aged 18-24.

The number and rate of suicides by patients within 3 months of discharge fell in 2013-2017 but have since risen. In the UK, the average rate of suicide over the report period was 14.1 per 10,000 discharges.

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Number and rate of mental health patients who died by suicide within 3 months of in-patient discharge in the UK and Jersey

Post-discharge suicide deaths were most frequent in the first 1-2 weeks after leaving hospital. Of patients who died in the first week after discharge, the highest number (63, 20%) occurred on day 3 after leaving hospital (day 1 = day of discharge) with higher numbers also occurring later in the week, i.e. days 4-6 compared to the first day of discharge. In 2019-22 the highest number occurred on day 6 (20 patients, 22%).

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Number of mental health patient deaths by suicide per week following discharge (UK and Jersey, 2012-2022)

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Number of mental health patient deaths by suicide per day in the week following discharge (UK and Jersey, 2012-2022)

Around a quarter (579, 27%) of patients who died within 3 months of discharge from in-patient care had been detained under the Mental Health Act (MHA) at their last admission; this proportion increased to 35% in 2019-2022. There were 262 (23%) patients known to have been discharged to housing, financial or employment problems.

198 (10%) patients died by suicide before their first follow-up appointment, especially those who died within 2 weeks of discharge (140, 25%). Overall, 184 (9%) had initiated their own discharge; higher in those who died within a week of discharge (47, 15%) and 227 (11%) died after being discharged from an in-patient unit which was out of their local area.

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