Kirsten Windfuhr – Safer Care
Suicide is one of the most serious adverse outcomes in mental health services.
One in 4 people who die by suicide had been in contact with mental health services in the 12 months prior to suicide. NCISH (National Confidential Inquiry into Suicide and Homicide by People with Mental ) research is based on the detailed analysis and modelling of an internationally unique and comprehensive database of individuals who died by suicide (91,000 suicides, of whom 24,000 were in contact with mental health services). NCISH impacts upon clinical practice and care policy in four areas: 1) providing professionals, mental health charities and government reports with figures that link services to mental health related suicide incidents, 2) producing data driven recommendations for mental health services to reduce suicide, 3) developing toolkits for quality improvement and local audits and 4) demonstrating that service change can reduce suicide rates. Based on NCISH research and adoption of its recommendations, patient suicide rates in mental health trusts have been reduced, with an estimated reduction in patient suicide of 200-300 deaths per year.
The aim of the research is to recommend changes to clinical practice and policy that will reduce the risk of suicide in mental health patients. We do this by maintaining a national register of all suicides occurring in the UK general population and collecting more detailed information directly from clinical teams on people who have been in contact with services in the previous 12 months. Our response rates from clinicians have been around 95% for the last 13 years, which is in marked contrast to rates of voluntary reporting before we set up the Inquiry in Manchester of around 20%. Much of our work is focussed on our core database, which is the largest clinical database of suicide internationally (96,000 general population suicides; 24,000 mental health patient suicides). However, we use a variety of research designs, including case-control, cohort, and qualitative methodologies. The longitudinal nature of the data collection is a major advantage allowing a detailed examination of trends.
NCISH has generated key findings on suicide by mental health patients that were unknown prior to its inception but are now established in clinical services and widely quoted (2, 5):
- 1,200 people (25% of all suicides occurring in the general population) are in contact with mental health services in the 12 months prior to suicide (2, 4, 5).
- Of this group, half are in contact with services in the week before death (4).
Over the 10 year period 2001-2010:
- Approximately one in ten patient suicides occur during an in-patient admission and the commonest cause of death is by hanging (4). A quarter of in-patient deaths occur after patients abscond from the ward (4).
- Nearly one in five patient suicides occurs within 3 months of discharge from in-patient care. The highest risk period is the first week after discharge, particularly the first 1 to 3 days (4, 5).
- In our case control study of suicides among community patients within 2 weeks of discharge from in-patient care, over half of patients died within a week of discharge and before their first follow-up appointment with mental health services. Receiving enhanced aftercare was a protective factor (7).
- 14% of patients are non-adherent with drug treatment in the month prior to suicide; 26% missed their final contact with mental health services prior to suicide (4).
Safer Care Ltd (2013) was established as a response to the needs of mental health services that could not be met through the remit of NCISH. Through Safer Care Ltd., we can provide: expert scrutiny of individual cases and service documentation (SUI reports, service policies) identified by services, identify themes arising from cases, place local services in the national context and provide a training seminar to all staff about their local issues, and the national picture. With a £5,000 award to Dr. Kirsten Windfuhr through the HEFCE, ULTD, University of Manchester UMI3 social enterprise award scheme, Safer Care Ltd. is now a non-profit, registered company limited by guarantee. To date, we have carried out four reviews and will continue to grow the business, reinvesting the funds in the social enterprise to meet the needs of services.