National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Annual Report 2014

National Confidential Inquiry Annual Report Annual report of key figures on suicide, homicide, SUD Final year 2012 (equates to ONS 2012-13) Final year contains estimates to allow for delayed returns UK-wide but focus on England because of larger numbers Recommendations for services

KEY FINDINGS Patient suicides

National Confidential Inquiry Suicide UK (1996-2012) N England Wales Scotland (1997-2012) N. Ireland General population 100,329 78,170 5,475 13,235 3,449 In contact with services 26,216 (26%) 20,300 1,260 (23%) 3,705 (28%) 951 UK_SUICIDE © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide rates in general population, UK UK_SUICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

10-year suicide rates in general population, UK by age-group UK_SUICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patient suicide - UK UK_SUICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patient suicide - England ENGLAND_SUICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patient suicide - Wales WALES_SUICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Post-discharge suicide

Post-discharge suicide - UK 3,225 suicides, 18% of all suicides average 293 per year 18% before follow-up 526 (17%) in first week after discharge UK_SUICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicides per week following discharge, England ENGLAND_SUICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide within 3 months of discharge, England ENGLAND_SUICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide within two weeks of hospital discharge Case-control study 100 post-discharge suicides and 100 living controls (England 2004-06) Independent risk factors: self-harm male gender aged ≥ 40 last admission <7 days adverse life events co-morbid psychiatric illness Under CPA protective SOURCE: NCI data, Psychiatric Services (2013)

Suicide under crisis resolution/ home treatment services

Suicides under CR/HT services - UK 1,943 suicides, 11% of all suicides average 177 per year 47% lived alone UK_SUICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide under CR/HT and in-patient care - England ENGLAND_SUICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Suicide under crisis resolution/home treatment teams 140 suicides per year (England 2003-11) Rate higher than among in-patients (14.6 per 10,000 CR/HT episodes vs. 8.8 per 10,000 admissions) Increase from 80 per year (2003-04) to 163 (2010-11) Rate has fallen 44% lived alone; 49% adverse life events; 34% died <3 months discharge SOURCE: NCI data, Lancet Psychiatry (2014)

Suicide method

General population suicide method - England ENGLAND_SUICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patient suicide method - England ENGLAND_SUICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patient suicide method UK: hanging UK_SUICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patient homicide

Homicide convictions UK N England Wales Scotland N. Ireland General (1996-2012) N England Wales Scotland (1997-2012) N. Ireland General population 10,974 8,959 416 1,329 270 In contact with services 1,133 (10%) 866 44 (11%) 191 (14%) 32 (12%) UK_HOMICIDE © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patient homicide - England ENGLAND_HOMICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Primary diagnosis in patient homicide in the UK UK_HOMICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Patients as victims of homicide 1,496 victims (England & Wales, 2003-05) 90 (6%) patient victims 29/90 killed by fellow patient (7 with schizophrenia) 21/29 both victim and offender at the same NHS Trust Alcohol/drug misuse and previous violence common among patient victims and perpetrators SOURCE: NCI data, Lancet Psychiatry (2014)

Intimate partner homicides

Intimate partner homicide, UK 1,152 IPH, 19% of all homicides average 105 per year 34% previous convictions for violence 149 (13%) by patients UK_HOMICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Intimate partner homicide by patients, England ENGLAND_HOMICIDE (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Sudden unexplained death (SUD) and restraint

Sudden unexplained death (1999-2012) England & Wales N England In-patient deaths 8,481 7,647 834 SUD 492 456 36 Sudden unexplained death © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Sudden unexplained death and restraint (England & Wales, 2002-2012) 380 sudden unexplained deaths 24 deaths <24 hours of restraint 6 deaths <1 hour of restraint 5 deaths <24 hours in 2012 ENGLAND_Sudden unexplained death (2002-2012) © National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved. Not to be reproduced in whole or part without the permission of the copyright holder.

Recommendations (1) 1. Patient suicides Address economic pressures facing patients (working with relevant agencies) 2. Suicide after discharge Effective care planning, addressing life events Early follow-up Caution over short admissions Suicide <3 days a ‘never event’

Recommendations (2) 3. Suicide under CR/HT Priority for suicide prevention Review suitability for certain patients 4. Suicide by hanging Media portrayals to be re-examined

Recommendations (3) Patient homicide Address co-morbidities through assertive outreach and alcohol/drug services 6. Intimate partner homicide Protect victims through treatment of perpetrator Multi-agency collaboration SUD Safe use of restraint Deaths/serious injury from restraint a ‘never event’

National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Website: http://www.bbmh.manchester.ac.uk/cmhr/research/ - Follow link to National Confidential Inquiry Like us on Facebook https://www.facebook.com/pages/Centre-for-Mental-Health-and-Risk Follow us on Twitter https://twitter.com/NCISH_UK