Mental Health in Scotland: Closing the Gaps - Making a Difference: Commitment 13

Suicide Prevention

The five year report of the National Confidential Inquiry ( NCI) into suicide and homicide by people with mental illness in England and Wales (University of Manchester 2006) gave detailed clinical information on current or recent mental health patients who die by suicide, defined as those who have been in contact with mental health services in the preceding 12 months. The NCI reported that 27% of patients who died had a "dual diagnosis" of severe mental illness (schizophrenia or affective disorder) and substance dependence/misuse.

Most of these suicides were mainly young, single, unemployed males living alone. The NCI also found that 8% of all the Inquiry cases had alcohol dependence as a primary diagnosis and 3% had drug dependency as a primary diagnosis. A further 44% had a history of alcohol abuse and 30% had a history of drug misuse.

The study found that 49% percent of the patients who died had been in contact with mental health services in the previous week, 19% in the previous 24 hours. Of those (dual diagnosis) patients who died while living in the community, 32% had missed their last appointment with services. Recent studies also show an increased risk in mortality (between 30 and 50 times) within a fortnight for those leaving prison, the chief cause being drug-related death and suicide.

At final contact, immediate suicide risk was estimated to be low or absent in 86% of cases, highlighting that suicide risk can change rapidly. These findings are based on all Inquiry cases (ie all those who died by suicide and had been in contact with mental health services in the year preceding death). The NCI report on Scottish data is scheduled for 2008.

The National Investigation into Drug Related Deaths in 2003 estimated that 13% such deaths were intentional overdoses (Scottish Government , 2005). Those dependent on alcohol have a lifetime suicide risk 8 times that of the general population (Foster 2001).

The Choose Life evaluation; research findings from 2006 stated that at a national level, key steps to promote mainstreaming in the next stages of implementation should recognise the importance of intervention where key suicide prevention actions are not taken at the local level including failure to integrate substance misuse treatment services into delivery plans. Community Planning Partnerships were also invited to review progress and put in place steps to establish or build on effective links with clinical drug and alcohol services.

Alcohol and Drug Action teams and Suicide Prevention groups should agree joint working arrangements to ensure that local actions reflect the close linkages between their work. In line with this NHS Boards should establish a mechanism to monitor alcohol related suicide trends.

Recommendation

1. Substance misuse staff identified as providing frontline services should be trained in suicide risk assessment and prevention. This will be an extension to the published 2006 commitment 7.