Coroners’ verdicts and suicide statistics in England and Wales

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d6030 (Published 6 October 2011)
Cite this as: BMJ 2011;343:d6030

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  1. David Gunnell, professor of epidemiology1,
  2. Keith Hawton, professor of psychiatry2,
  3. Nav Kapur, professor of psychiatry and population health3
  1. 1School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
  2. 2 Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK
  3. 3Centre for Suicide Prevention Community Based Medicine, University of Manchester, Manchester, UK
  1. d.j.gunnell{at}bristol.ac.uk

Increasing use of narrative verdicts raises serious concerns

Suicide is the most tragic consequence of mental illness, and it accounted for 4648 deaths in England and Wales in 2009.1 Reliable suicide statistics are essential to inform and evaluate suicide prevention strategies,2 highlight changes in rates (perhaps as a result of changing socioeconomic conditions), and detect emergence of new methods of suicide.3

Suicide statistics in England and Wales are derived from death certificates issued after coroners’ inquests into unnatural or unexpected deaths. Around 30 000 such inquests are held each year, and coroners usually give a “short form” verdict for the cause of death—the most commonly recorded verdicts are accident, natural causes, suicide, industrial disease, and “open.”4 Most deaths given open verdicts are likely to be suicides.5 However, the legal requirements for identifying suicide (beyond reasonable doubt) differ from the less stringent criteria used by health professionals.6 Furthermore, some coroners may give open or accidental verdicts in the belief that this avoids adding to a family’s distress.7 For these reasons official suicide statistics produced by the Office for National Statistics (ONS) combine suicide and open verdict deaths.8

Suicide statistics have long been recognised as imperfect.9 Suicides may be especially difficult to identify when methods such as drowning and overdose are used and intent is unclear.10 Suicide rates are therefore likely to be underestimated, but recent research by the ONS signals a new and growing problem with the accuracy of national data.11

Since 2001 a growing number of coroners have summarised their inquest findings with a “narrative verdict”—which records, in several sentences, how, and in what circumstances, the death occurred—rather than giving a short form verdict. The numbers of narrative verdicts …

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