Leading mental health charities have called for more support to be provided to people with mental ill health on leaving hospital, after research showed that service users are at their highest risk of dying by suicide in the first few weeks after discharge.
The University of Manchester's National Confidential Inquiry into Suicide and Homicide by People with Mental Illness found that about 3,225 patients died by suicide in the UK within the first three months of their discharge from hospital – 18% of all patient suicides – between 2002 and 2012.
Peak time of risk was found to be the first week after discharge in England, Northern Ireland and Scotland, where 526 patients died. In Wales, it is the first two weeks.
The report also highlighted 24 deaths in England and Wales in patients who had been restrained by ward staff in the previous 24 hours. Five of these deaths occurred in 2012.
The research team call for suicides within 3 days of hospital discharge and deaths and serious injuries caused by restraint to be NHS ‘never events’.
Professor Louis Appleby (pictured), director of the National Confidential Inquiry, who led the study said: “Our latest data shows the first 3 months after discharge remain the time of highest risk but especially in the first 1-2 weeks. This increased risk has been linked to short admissions and to life events so our recommendations are that careful and effective care planning is needed including for patients before they are discharged and for those who self-discharge.
“Early follow-up appointments should be strengthened and reducing the length of in-patient stay to ease pressure on beds should not be an aim in itself. Instead health professionals should ensure the adverse events that preceded the admission have been addressed.”
Paul Farmer, chief executive of Mind, expressed his shock at the findings. “This [first few weeks after discharge] is an important time in someone’s steps towards recovery when they need quality help and support around them. We need to understand why this is happening and make sure that action is being taken to better support people after they are discharged from hospital.
“Mind’s own research has shown that, in many parts of the country, crisis care teams are under-resourced, understaffed and overstretched. We have also heard about beds being cut and the sometimes desperate struggle that people face in finding a bed which can mean being sent miles away from home. We would be very concerned if this pressure on beds and budget cuts means that patients are now being discharged from hospital before they are ready, putting them at risk. With the General Election now under a year away, the next government needs to commit to increasing investment in mental health – there really isn’t any room for belt tightening.”
Farmer was also upset to see the number of deaths following incidents of restraint in 2012. “Pinning someone face down on the floor is humiliating, dangerous and as these statistics show can be fatal,” he said. “We have seen some welcome developments this year in working towards an end to face down restraint, particularly the new guidance about restraint issued earlier this year. We hope that with its implementation we will see an end to the use of face down restraint and that deaths and serious injuries can be made a ‘never event’ in the NHS.”
Mark Winstanley, CEO of Rethink Mental Illness, added: “These new stats highlight the serious lack of support available to people with mental illness in the community. The fact that so many people take their own lives within two weeks of leaving hospital clearly shows that we need more services in place to help people recover from a crisis. Far too many people are also missing out on crucial treatments such as Early Intervention, which would make a huge difference in helping them avoid reaching crisis point in the first place.
“This is completely unacceptable. We know which services are most effective in helping people recover from mental illness, and offer the NHS significant long-term savings. Now we need the Government to invest in those services as an urgent priority. Not only will it save money, but more importantly it will save lives too.”
The National Confidential Inquiry also found that fall in homicides committed by mental health patients reported last year for England was sustained but there was no further fall. Between 2002 and 2012 828 people convicted of homicide in the UK have been confirmed as mental health patients, on average 75 per year. A total 66 homicides were recorded in 2012 in the UK.
“It’s also really important to put into perspective the figures about homicides by people who use mental health services,” Winstanley added. “Each and every death in these circumstances is absolutely tragic, and we do not in any way want to dismiss the pain caused to the individual families involved. But it is important that the public understand how small the real risk is. Violent crimes of any nature by people with mental illness are extremely rare, and these stats show that the numbers have decreased over the past few years.
“In fact, 95% of all homicides are committed by people who don’t have a mental health problem. But because we often talk about conditions like schizophrenia in the context of a violent incident, it’s created a false association between mental illness and violence. We don’t hear about the vast majority of people with mental health problems who are quietly getting on with their lives and pose no threat to anyone.”