Intended for healthcare professionals


New standard of proof for suicide at inquests in England and Wales

BMJ 2019; 366 doi: (Published 29 July 2019) Cite this as: BMJ 2019;366:l4745
  1. Louis Appleby, professor of psychiatry1,
  2. Pauline Turnbull, project director1,
  3. Nav Kapur, professor of psychiatry and population health12,
  4. David Gunnell, professor of epidemiology3,
  5. Keith Hawton, professor of psychiatry4
  1. 1National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
  2. 2Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
  3. 3Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
  4. 4Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK
  1. Correspondence to: P Turnbull p.turnbull{at}

Suicide can now be concluded on “balance of probabilities”

In May 2019 the Court of Appeal in England and Wales handed down a ruling on the determination of suicide at inquest that is likely to affect the national suicide rate and influence policy priorities.1 The ruling upholds a critical decision taken in 2018 by the High Court2 that the standard of proof required for a suicide conclusion (previously verdict) should be the civil standard—balance of probabilities—rather than the previous criminal standard—beyond reasonable doubt. The lowering of the threshold is expected to lead to an increase in deaths recorded as suicide.

The standard of proof has been debated for several years. Suicide prevention charities, in particular, have campaigned for the civil standard, arguing that it will give a more accurate picture of the extent of the problem by reducing the underestimation that a higher standard makes inevitable.3 Higher figures, they believe, will also bring higher political priority. In addition, the criminal standard is widely seen as stigmatising, a …

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