title: Mental health services, suicide and 7-day working.
abstract: Patients admitted to hospital at the weekend appear to be at increased risk of death compared with those admitted at other times. However, a 'weekend effect' has rarely been explored in mental health and there may also be other times of year when patients are vulnerable.
  
  
  
  To investigate the timing of suicide in high-risk mental health patients.
  
  
  
  We compared the incidence of suicide at the weekend v. during the week, and also in August (the month of junior doctor changeover) v. other months in in-patients, patients within 3 months of discharge and patients under the care of crisis resolution home treatment (CRHT) teams (2001-2013).
  
  
  
  The incidence of suicide was lower at the weekends for each group (incidence rate ratio (IRR) = 0.88 (95% CI 0.79-0.99) for in-patients, IRR = 0.85 (95% CI 0.78-0.92) for post-discharge patients, IRR = 0.87 (95% CI 0.78-0.97) for CRHT patients). Patients who died by suicide were also less likely to have been admitted at weekends than during the week (IRR = 0.52 (95% CI 0.45-0.60)). The incidence of suicide in August was not significantly different from other months.
  
  
  
  We found evidence of a weekend effect for suicide risk among high-risk mental health patients, but with a 12-15% lower incidence at weekends. Our study does not support the claim that safety is compromised at weekends, at least in mental health services.
authors.affiliation: Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK nav.kapur@manchester.ac.uk.
authors.forename: Nav
authors.initials: N
authors.lastname: Kapur
authors.affiliation: Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
authors.forename: Saied
authors.initials: S
authors.lastname: Ibrahim
authors.affiliation: Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
authors.forename: Isabelle M
authors.initials: IM
authors.lastname: Hunt
authors.affiliation: Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
authors.forename: Pauline
authors.initials: P
authors.lastname: Turnbull
authors.affiliation: Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Shaw
authors.affiliation: Nav Kapur, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester and Manchester Mental Health and Social Care Trust, Manchester, UK; Saied Ibrahim, PhD, Isabelle M. Hunt, PhD, Pauline Turnbull, PhD, Jenny Shaw, FRCPsych, Louis Appleby, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
authors.forename: Louis
authors.initials: L
authors.lastname: Appleby
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D013405:Suicide / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult