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

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

3. KEY FINDINGS
Patient suicides

4. National Confidential Inquiry
Suicide UK
( ) N
England
Wales
Scotland
( )
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
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5. Suicide rates in general population, UK
UK_SUICIDE ( )
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
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6. 10-year suicide rates in general population,
UK by age-group
UK_SUICIDE ( )
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
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7. Patient suicide - UK UK_SUICIDE (2002-2012)
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8. Patient suicide - England
ENGLAND_SUICIDE ( )
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9. Patient suicide - Wales
WALES_SUICIDE ( )
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10. Post-discharge suicide

11. 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 ( )
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12. Suicides per week following discharge, England
ENGLAND_SUICIDE ( )
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13. Suicide within 3 months of discharge, England
ENGLAND_SUICIDE ( )
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
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14. Suicide within two weeks
of hospital discharge
Case-control study 100 post-discharge suicides and 100 living controls (England )
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)

15. Suicide under crisis resolution/
home treatment services

16. Suicides under CR/HT services - UK
1,943 suicides, 11% of all suicides
average 177 per year
47% lived alone
UK_SUICIDE ( )
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17. Suicide under CR/HT and in-patient care - England
ENGLAND_SUICIDE ( )
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
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18. Suicide under crisis resolution/home treatment teams
140 suicides per year (England )
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 ( ) to 163 ( )
Rate has fallen
44% lived alone; 49% adverse life events; 34% died <3 months discharge
SOURCE: NCI data, Lancet Psychiatry (2014)

19. Suicide method

20. General population suicide method - England
ENGLAND_SUICIDE ( )
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
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21. Patient suicide method - England
ENGLAND_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.

22. Patient suicide method UK: hanging
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.

23. Patient homicide

24. Homicide convictions UK N England Wales Scotland N. Ireland General
( ) N
England
Wales
Scotland
( )
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.
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25. Patient homicide - England
ENGLAND_HOMICIDE ( )
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
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26. Primary diagnosis in patient
homicide in the UK
UK_HOMICIDE ( )
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
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27. Patients as victims of homicide
1,496 victims (England & Wales, )
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)

28. Intimate partner homicides

29. 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 ( )
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
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30. Intimate partner homicide by patients, England
ENGLAND_HOMICIDE ( )
© National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. All rights reserved.
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31. Sudden unexplained death (SUD)
and restraint

32. 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.
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33. Sudden unexplained death and restraint
(England & Wales, )
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 ( )
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34. 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’

35. 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

36. 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’

37. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness
Website:
- Follow link to National Confidential Inquiry
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