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9. 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 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.
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 late 2007.
The Scottish Review of Drug Related Deaths in 2003 estimated that 13% such deaths were intentional overdoses ( CARES 2005). Those dependent on alcohol have a lifetime suicide risk 8 times that of the general population (Foster 2001.)
Recommendations
Substance misuse services should be involved in and provide training in suicide risk assessment and prevention in line with commitment 7 in Delivering for Mental Health.
Drug Related Death Monitoring Groups and Choose Life and Suicide Prevention Groups within each locality in Scotland should work together to ensure that local actions reflect the close linkages between their work. NHS boards should establish a mechanism to monitor alcohol related suicide trends.
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