title: Psychiatric in-patient care and suicide in England, 1997 to 2008: a longitudinal study.
abstract: BACKGROUND
  Psychiatric in-patients are at high risk of suicide. Recent reductions in bed numbers in many countries may have affected this risk but few studies have specifically investigated temporal trends. We aimed to explore trends in psychiatric in-patient suicide over time.
  
  
  METHODS
  A prospective study of all patients admitted to National Health Service (NHS) in-patient psychiatric care in England (1997-2008). Suicide rates were determined using National Confidential Inquiry and Hospital Episode Statistics (HES) data.
  
  
  RESULTS
  Over the study period there were 1942 psychiatric in-patient suicides. Between the first 2 years of the study (1997, 1998) and the last 2 years (2007, 2008) the rate of in-patient suicide fell by nearly one-third from 2.45 to 1.68 per 100,000 bed days. This fall in rate was observed for males and females, across ethnicities and diagnoses. It was most marked for patients aged 15-44 years. Rates also fell for the most common suicide methods, particularly suicide by hanging on the ward (a 59% reduction). Although the number of post-discharge suicides fell, the rate of post-discharge suicide may have increased by 19%. The number of suicide deaths in those under the care of crisis resolution/home treatment teams has increased in recent years to approximately 160 annually.
  
  
  CONCLUSIONS
  The rate of suicide among psychiatric in-patients in England has fallen considerably. Possible explanations include falling general population rates, changes in the at-risk population or improved in-patient safety. However, a transfer of risk to the period after discharge or other clinical settings such as crisis resolution teams cannot be ruled out.
authors.affiliation: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Risk, University of Manchester, UK. nav.kapur@manchester.ac.uk
authors.forename: N
authors.initials: N
authors.lastname: Kapur
authors.forename: I M
authors.initials: IM
authors.lastname: Hunt
authors.forename: K
authors.initials: K
authors.lastname: Windfuhr
authors.forename: C
authors.initials: C
authors.lastname: Rodway
authors.forename: R
authors.initials: R
authors.lastname: Webb
authors.forename: M S
authors.initials: MS
authors.lastname: Rahman
authors.forename: J
authors.initials: J
authors.lastname: Shaw
authors.forename: L
authors.initials: L
authors.lastname: Appleby
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004739:England / Q000453:epidemiology; D005260:Female; D006778:Hospitals, Psychiatric / Q000639:trends; D006801:Humans; D007297:Inpatients; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D013405:Suicide / Q000639:trends; D013997:Time Factors; D055815:Young Adult