Letters

Suicide after discharge from psychiatric hospitals in Scotland

Geddes and Juszczak argue that the changes may be related to decreases in the number of psychiatric beds, and they call for the retention of inpatient facilities. If death rates in females in the 28 days after discharge had returned to the same level that existed in 1968-72 then 12 deaths would have been prevented in 1988-92. This represents only 1.18% of all suicides and undetermined deaths in females in Scotland in the five years and 0.32% of these deaths in both sexes. We have reported previously that only 9.5% of males and 18.4% of females who died by suicide in 1991-2 in Scotland had been psychiatric inpatients in the 12 months before their death.² This, together with the finding that most people dying by suicide have not had recent contact with their general practitioners,³ brings into question the concentration of efforts to prevent suicide on health care services.

View larger version (11K): [in this window] [in a new window]   Deaths by suicide in 1991-2 after discharge from psychiatric hospitals in Scotland

While supporting the need for good planning for patients' discharge, we believe that efforts should continue to identify other routes of intervention in the great majority of those dying by suicide, who have not been in contact with primary care or inpatient psychiatric services. Detailed examination of high risk groups, such as younger people and those in deprived communities,⁴ together with review of the scope for structural interventions, such as limiting the availability of popular methods of suicide,⁵ may offer the greatest population benefits.

Consultant in public health medicine Ayrshire and Arran Health Board, Ayr KA7 4DW

Consultant psychiatrist Crichton Royal Hospital, Dumfries DG1 4TG

Health information scientist Record Linkage Project, Information Services Directorate, Edinburgh

Consultant in public health medicine Argyll and Clyde Health Board, Paisley PA1 1DU

Cameron Stark, David Hall, Fiona O'Brien, Helen Smith 

1. Geddes JR, Juszczak E. Period trends in rate of suicide in first 28 days after discharge from psychiatric hospital in Scotland, 1968-92. BMJ 1995;311:357-60. (5 August.) [Abstract/Free Full Text]
2. Stark C, Smith H, Hall D, O'Brien F. Prevention of suicide. BMJ 1994;309:1089. [Free Full Text]
3. Vassilas CA, Morgan HG. General practitioners' contact with victims of suicide. BMJ 1993;307:300-1.
4. Gunnell DJ, Peters T, Kammerling RM, Brooks J. Relation between parasuicide, suicide, psychiatric admissions, and socioeconomic deprivation. BMJ 1995;311:226-30. (22 July.) [Abstract/Free Full Text]
5. Gunnell D, Frankel S. Prevention of suicide: aspirations and evidence. BMJ 1994;308:1227-33. [Free Full Text]