Impact of national policy initiatives on fatal and non-fatal self-harm after psychiatric hospital discharge: time series analysis.
BACKGROUND
Risk of self-harm and suicide is greatly increased in the period after discharge from psychiatric in-patient care.


OBJECTIVE
To investigate the impact on suicide of a series of policy initiatives to enhance care in the immediate post-discharge period.


METHODS
A time series analysis was based on 1997-2007 data from the National Confidential Inquiry into Suicide and from Hospital Episode Statistics for England.


RESULTS
There was no evidence of a reduced risk of suicide in the first 12 weeks following discharge in 2003-2007 compared with 1997-2002. In contrast, the relative risk of non-fatal self-harm in the 12 weeks after discharge declined. The risk ratio for self-harm (2003-2007 v. 1997-2002) at 0-1 week post-discharge was 0.86 (95% CI 0.80-0.92) and at 2-4 weeks it was 0.89 (95% CI 0.85-0.94).


CONCLUSIONS
These findings provide some support for the impact of recent policy changes on the risk of non-fatal self-harm in the immediate period after discharge from psychiatric in-patient care.
School of Social and Community Medicine, 39 Whatley Road, University of Bristol, Bristol BS8 2PS, UK. d.j.gunnell@bristol.ac.uk
David
D
Gunnell
Chris
C
Metcalfe
David
D
While
Keith
K
Hawton
Davidson
D
Ho
Louis
L
Appleby
Nav
N
Kapur
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003156:Community Mental Health Services / Q000592:standards / Q000706:statistics & numerical data; D004739:England; D006291:Health Policy; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011379:Prognosis; D011787:Quality of Health Care; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D013405:Suicide / Q000706:statistics & numerical data; D055815:Young Adult