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LETTERS: Alison Lowe, Emma Heap, Stirling Moorey, George Tadros, Emad Salib, M D Beary, Louis Appleby, and Jenny Shaw Suicide within 12 months of contact with mental health services BMJ 1999; 319: 1433b [Full text]

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Implications for general practice

Andrew Thornett   (29 November 1999)

Implications for general practice 29 November 1999
Andrew Thornett, Clinical Research Fellow department of Psychiatry, University of Southampton Send response to journal: Re: Implications for general practice	Dear Sir, Professor Appleby's findings (1) are of immense importance to general practitioners. His finding that 24% of those killing themselves had been discharged from a psychiatric hospital within the last three months represents increasing evidence of the serious risk this patient group represents (2), and the need for the primary mental health team to closely monitor these patients during this period. However, within most practices it is not possible to provide the close surveillance needed. General practitioners are not to blame for this difficulty. The NHS functions by efficiently treating large numbers of patients, which inevitably leads to “conveyor belt health care”. While such care is efficient and for the most part effective, it results in some people falling through the net. For most patients, this is not a significant problem as they will seek out further care or chase missed appointments. However, mental illness represents an exception, with these individuals being less likely to seek medical help as they become more unwell. The care provided by primary care teams needs to be re-organised to ensure that increased surveillance of at-risk patients can be provided. Modern computer systems can make patient registers a reality that flag up those that have not attended for defined lengths of time, and we may need to re-introduce regular visiting for these individuals. However, the best solution may be provided by closer integration of secondary care mental health services with primary care, perhaps by holding clinics and team meetings in surgeries where members of the primary mental health team can also attend. This level of integration has the potential to tackle this serious problem and provide us with a real opportunity to reach the government targets for suicide prevention (3). (1) Appleby, L., Shaw, J., Amos, T., McDonnell, R., Harris, C., McCann, K., Kiernan, K., Davies, S., Bickley, H., Parsons, R. Suicide within 12 months of contact with mental health services: national clinical survey. BMJ 1999, 1235-1239. (2) Geddes, J.R., Juszczak, E. Period trends in rate of suicide in first 28 days after discharge from psychiatric hospital in Scotland, 1968- 92. BMJ 1995;311:357-360. (3) Secretary of State for Health. The health of the nation: a strategy for health in England. London: HMSO, 1992.