1. Suicide Data Information for London CCG Mental Health Leads Henrietta Hughes March 2015

2. UK (1996-2012) N England (1996-2012) N Wales (1996-2012) N Scotland (1997-2012) N N. Ireland (1997-2012) N General population 100,32978,1705,47513,2353,449 In contact with services 26,216 (26%) 20,300 (26%) 1,260 (23%) 3,705 (28%) 951 (28%) National Confidential Inquiry Suicide 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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)

9. 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 under CR/HT services - UK 1,943 suicides, 11% of all suicides average 177 per year 47% lived alone

10. 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)

11. 37% of people who died by suicide had not seen their GP in the previous year. Risk was increased by 67% in non-attenders. Suicide risk also increased with increasing number of GP consultations, particularly in the 2 to 3 months prior to suicide. In those who attended more than 24 times, risk was increased 12-fold. 37% of those who died by suicide did not have a mental health diagnosis recorded on the database at any time. 52% had not been prescribed psychotropic drug treatment in the year before they died. Patients who died were more likely to be receiving psychotropic medication than living patients. Lithium was associated with a lower suicide risk than other groups of drugs; benzodiazepines were associated with a suicide risk equivalent to antidepressants. Being prescribed more than one type of drug was associated with an 11-fold increase in suicide risk. Only 8% of patients who died had been referred to specialist mental health services in the previous 12 months. SUICIDE IN PRIMARY CARE 2001 – 2011 (PUBLISHED July 2014)

12. Key messages for services In primary care patients who die by suicide, mental illness is frequently unrecognised. Suicide risk is associated with frequent attendance, increasing attendance, and non-attendance. Markers of risk in those attending include frequent consultation, multiple psychotropic drugs, and specific drug combinations such as benzodiazepines with antidepressants. These markers could be the basis of a “flag” alert in primary care records, leading to further assessment. The current Health Check in primary care should be amended to include mental health, as a step to identifying risk in non-attenders. Suicide prevention in primary care non-attenders will have to rely on other agencies including the voluntary sector and internet based supports who may be better able to maintain contact with young people at risk.