The number of men who die by suicide while under the care of mental health services in the UK has risen by 29% since 2006, a new report has revealed.
The report, by The University of Manchester’s National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH), also found that during the 2003-2013 report period the largest rise was seen in men aged 45-54, where there has been a 73% increase since 2006. This may be driven by increases in risk factors such as alcohol and economic pressures.
Professor Louis Appleby, director of NCISH, said: “The problem is not simply that [middle-aged men] don't seek help - they are already under mental health care - so we have to understand better the stresses men in this age group face.”
The NCISH report, commissioned by the Healthcare Quality Improvement Partnership as part of the Clinical Outcome Review Programmes, also highlighted the rise in deaths among patients treated under Crisis Resolution or Home Treatment (CR/HT) services, introduced as an alternative to in-patient admission.
Suicides under CR/HT are now three times greater than the number of deaths occurring in mental health in-patient settings in England, with an estimated 226 deaths in 2013. The number of suicide deaths following discharge from a non-local in-patient unit has also risen in recent years.
“Our findings suggest that the pressures facing mental health services are being seen mainly in the safety of home treatment and reduced availability of local beds,” Appleby added. “Commissioners and providers should review the safety of their acute services. In particular, acute admissions out of area should cease as they are likely to make care planning more difficult and increase suicide risk for patients at the time of discharge.”
The most common type of drug taken in fatal overdose by mental health patients is now opiates - 141 deaths in 2013 across the UK, and a total of 1,215 suicides over the study period. In around half of these deaths, the source of opiates is prescription, mainly for the patient, though sometimes for someone else. Those who died by opiate poisoning were more likely to have had a major physical illness than patients who used other methods.
Professor Navneet Kapur, head of suicide research at NCISH and a report author, added: “Healthcare professionals should be aware of the risks from opiate-containing painkillers. Patients’ access to these drugs should be checked and prescribing should be monitored to reduce the risk of accumulating large quantities at home.
“Better monitoring of physical illness among mental health patients may also help to reduce suicide.”
Working more closely with families
The report highlights that working more closely with families could play a greater part in suicide prevention. Staff reported that greater involvement of the family by the service might have reduced the risk of suicide in 14% of cases – 2,338 deaths over the whole study period; this figure was higher for homicide.
One example of how services and families could work better together is in how services respond to missed appointments. The authors’ figures show that in only 22% of cases had the service contacted the family when the patient missed what turned out to be their final appointment.
Professor Jenny Shaw, head of homicide research at NCISH and a report author, said: “Our findings suggest that families are an under-used but vital resource to reduce suicide and homicide. Services should work closely with families when preparing plans for hospital discharge and crisis plans. It should also be easier for families and staff to share concerns with each other.”
Mental health charities have reacted with dismay to the rise in suicides among men, and have renewed calls for more funding for mental health care services.
“It’s utterly disheartening to see the number of suicides on the rise,” said Brian Dow, director of external affairs at Rethink Mental Illness. “It gives us further indication of a mental health care system that’s under so much pressure that some areas simply give way, and with tragic consequences.
“We know from listening to those we support through our services that when you’re in a crisis and don’t get the care and support you need, you can get dangerously close to breaking point. We hear from people who have been sent miles away from home because there are no beds close by, too far for family and friends to visit. Sadly far too many end up in this situation and feel like they have no way out.
“In the recent Budget we heard that an additional £10 billion will be invested in the NHS each year, but what we now need to know is how much of this is going towards mental health, to ensure people get the support they need, and when they need it.”
Paul Farmer, chief executive of Mind, agreed: “Earlier this year the Government announced its ambition to eliminate suicides among people in touch with mental health services. Today’s report shows just how far there is to go in achieving that goal. No one who is in touch with services, asking for help, should reach the point of taking their own life. NHS mental health services must be able respond when people reach out, from early treatment to help prevent people becoming more unwell, to an emergency response that can provide urgent care when someone in in crisis.
“This report recognises that investment in mental health services is key. However, historical underfunding for mental health, compounded by cuts over the last few years, mean that services are struggling to cope with demand.
“There is good work being done as part of the Crisis Care Concordat that will help improve support for people who are suicidal. Every local area now has an action plan that describes in detail how local NHS, police, local authorities and other agencies and services will work together to improve support for people in crisis and many include specific activity around suicide prevention. We need now to see these action plans become a reality and the right resources put behind them to transform the support available.”