Suicide and homicide by people with mental illness

doi:10.1136/bmj.318.7193.1225

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We still don't know how to prevent most of these deaths

John Geddes, Honorary consultant psychiatrist (john.geddes@psych.ox.ac.uk)

Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX

Papers pp 1235, 1240

The national confidential inquiry into suicide and homicide by people with mental illness began in 1992 in response to concern about mental health services in the United Kingdom. The usefulness of the initial reports was limited by the disappointing case ascertainment rate.1^–3 Two papers in this issue (pp 1235, 1240) 4 5 report the methods and results of Safer Services, the 1999 inquiry report.6 Case finding has now been much improved and the new report provides a valuable descriptive cross section of the characteristics of suicides and homicides in relation to the mental health services.

About 1000 people who commit suicide each year (a quarter of all UK suicides) and about 40 of those who commit homicide (about 8% of all UK homicides) have had some contact with the mental health services in the year before death. In patients committing suicide comorbidity, including substance misuse, and previous self harm are common. In people convicted of homicide, personality …