Intended for healthcare professionals


Suicide within 12 months of contact with mental health services

BMJ 1999; 319 doi: (Published 27 November 1999) Cite this as: BMJ 1999;319:1433

Local data vary from national data

  1. Alison Lowe, consultant psychiatrist (,
  2. Emma Heap, consultant psychiatrist,
  3. Stirling Moorey, consultant psychiatrist
  1. St Ann's Hospital, London N15 3TH
  2. Homerton Hospital, London E9 6SR
  3. Little Bromwich Centre, Northern Birmingham Mental Health Trust, Birmingham B9 5SF
  4. Hollins Park Hospital, Warrington WA2 8WA
  5. Grovelands Priory Hospital, London N14 6RA
  6. National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Department of Psychiatry, Withington Hospital, Manchester M20 8LR

    EDITOR—Appleby et al's paper on suicide and contact with mental health services has limitations compared with local data. 1

    A suicide audit team has existed in City and Hackney Community Services NHS Trust since 1995 and gathers information on sudden unexpected deaths of local residents from coroners' inquests and hospital records. We have difficulties because local coroners do not return information because of resource pressures. Local data were not returned to the national mortality programme on drug related deaths, 2 and we are concerned that the national confidential inquiry into suicide and homicide by people with mental illness may have experienced similar problems.3 Complex boundary issues in east London and a high density, highly mobile population make psychiatric contacts difficult to trace, and hospitals' patient information databases are inaccurate: fewer than half the people on whom the team collects inquest data are registered as dead.

    We identified 84 unexpected deaths in two years. For 12 the coroner's verdict was suicide or equivalent, and for 30 it was an open verdict. Collating available information on these 42 deaths (suicide by Appleby et al's method), we judged 27 to be probable suicide and two to be due to drug and alcohol overdoses; in 13 cases the cause of death was “unascertained.” We identified eight further deaths as probable suicides, although the coroner's verdict was misadventure or accidental death. For example, a 29 year old woman died from an overdose of tricyclic antidepressants and alcohol and left an explicit suicide note but a verdict of misadventure was given. This produces a classification discrepancy of 23 cases between the methods used by the local team and the national confidential inquiry.

    Among suicides that would have been identified by the national confidential inquiry, 9 of the 42 (21%) people who committed suicide had contact …

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