Find out which mental health services have the biggest impact on reducing suicide rates

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Every year in England and Wales, a suicide occurs in roughly one patient for every thousand in mental health treatment.

These numbers make it hard to research what mental health service providers can do to prevent further suicides, so it’s encouraging to see a new cross-sectional observational study published in the Lancet with funding from the National Patient Safety Agency.

The study set out to examine the uptake of key mental health service recommendations over time and to investigate the association between their implementation and suicide rates.

The researchers took 9 recommendations made in the National Confidential Inquiry into Suicide and Homicide by People in 2001 and assessed how they had been implemented in 91 Trusts in England and Wales.

They carried out a before-and-after analysis looking at people who killed themselves between 1997 and 2006 who were in contact with mental health services in the 12 months before death.

They compared the rates of suicide in different services who had implemented recommendations to varying degrees. The results were stratified for socioeconomic deprivation and the size of service provider.

Here’s what they found:

  • Services implemented more recommendations as time went on (0·3 per service in 1998 to 7·2 in 2006)
  • Unsurprisingly, lower suicide rates were associated with the implementation of recommendations
  • The biggest falls in suicide rates were associated with:
    • 24-hour crisis care: from 11·44 per 10,000 patient contacts per year (95% CI 11·12—11·77) before to 9·32 (8·99—9·67) after (p<0·0001)
    • Local policies on patients with dual diagnosis (10·55; 10·23—10·89 before vs 9·61; 9·18—10·05 after, p=0·0007)
    • Multidisciplinary review after suicide (11·59; 11·31—11·88 before vs 10·48; 10·13—10·84 after, p<0·0001)
  • Services with the most deprived catchment areas (incidence rate ratio 0·90; 95% CI 0·88—0·92) and the most patients (0·86; 0·84—0·88) saw the biggest falls in suicide

The researchers concluded:

Our findings suggest that aspects of provision of mental health services can affect suicide rates in clinical populations. Investigation of the relation between new initiatives and suicide could help to inform future suicide prevention efforts and improve safety for patients receiving mental health care.

If you need help

If you need help and support now and you live in the UK or the Republic of Ireland, please call the Samaritans on 116 123.

If you live elsewhere, we recommend finding a local Crisis Centre on the IASP website.

We also highly recommend that you visit the Connecting with People: Staying Safe resource.


While D, Bickley H, Roscoe A, Windfuhr K, Rahman S, Shaw J, Appleby L, Kapur N. Implementation of mental health service recommendations in England and Wales and suicide rates, 1997—2006: a cross-sectional and before-and-after observational study. The Lancet, Early Online Publication, 2 February 2012. [Abstract]

Kmietowicz Z. A fifth of suicides among people with mental illness are preventable. BMJ. 2001 Mar 17;322(7287):633.

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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